Comparison of Rectal, Axillary, Abdominal Skin and Tympanic Membrane Temperature Measurements in Term and Preterm Neonates

A quasi-experimenal study was conducted to investigate the optimum time and accuracy of temperature measurements from four sites: rectum (2.5 cm and 3 cm beyond the anus in preterm and term neonates, respectively), axilla (with mercury-in-glass thermometers), abdominal skin (with Duotemp Temperature Monitor), and tympanic membrane (with FirstTemp Genius Infrared Tympanic Thermo-meter in the rectal-equivalent mode). A convenience sampling technique was utilized to enroll 109 neonates, 52 stable preterm and 57 healthy term neonates from a nursery of a university medical center. Simultaneous measurements were made at the four sites by three observers. Each infant was studied only once. The highest temperatures were recorded when temperature readings remained unchanged for two minutes. The findings demonstrated that the rectal temperature was significantly higher than the axillary (mean differences of 0.06 and 0.09 oC in preterm and term neonates, respectively) and the abdominal skin temperatures (0.3 oC in preterm and 0.2 oC in term neonates). However, the differences between rectal and axillary temperatures were considered no clinical significance. Tympanic temperatures were significantly higher than the rectal. The mean differences between tympanic and rectal temperatures varied widely depending on the ear side (0.88 and 0.52 oC for protected ears, 0.63 and 0.21 oC for exposed ears in preterm and term infants, respectively). The temperatures of preterm neonates were not significantly different from the term neonates measured at rectum, axilla, and abdominal skin. Preterm neonates required shorter times to achieve highest temperatures at all sites. There were significant differences in the mean times of axillary and abdominal skin measurements between preterm and term neonates. The mean times of placement in preterm and term neonates, 2.8 and 3.4 minutes for rectum, 5.4 and 7.9 minutes for axilla, and 4.0 and 6.1 minutes for abdominal skin, were considered the optimum times since 91 to 100 per cent of neonates had temperature readings within their highest temperatures - 0.1 oC. Conclusion : The axillary temperature is as accurate as rectal temperature measured with mercury- in-glass thermometer if the placement times are optimum. The rectal temperature equals the abdominal skin plus 0.3 oC for preterm and plus 0.2 oC for term neonates. Temperatures obtained with infrared tympanic thermometer in the rectal equivalent mode do not accurately reflect and is not recommended to substitute for rectal temperatures in neonates

Early detection of cold stress to prevent hypothermia: A narrative review

Temperature monitoring is essential for assessing neonates and providing appropriate neonatal thermal care. Thermoneutrality is defined as the environmental temperature range within which the oxygen and metabolic consumptions are minimum to maintain normal body temperature. When neonates are in an environment below thermoneutral temperature, they respond by vasoconstriction to minimise heat losses, followed by a rise in metabolic rate to increase heat production. This condition, physiologically termed cold stress, usually occurs before hypothermia. In addition to standard axillary or rectal temperature monitoring by a thermometer, cold stress can be detected by monitoring peripheral hand or foot temperature, even by hand-touch. However, this simple method remains undervalued and generally recommended only as a second and lesser choice in clinical practice. This review presents the concepts of thermoneutrality and cold stress and highlights the importance of early detection of cold stress before hypothermia occurs. The authors suggest systematic clinical determination of hand and foot temperatures by hand-touch for early detection of physiological cold stress, in addition to monitoring core temperature for detection of established hypothermia, particularly in low-resource settings

Clinical detection of 'cold stress' is overlooked : an online survey of healthcare workers to explore the gap in neonatal thermal care in low-resource settings

Background: Neonatal hypothermia has been widely regarded as a major contributory factor to neonatal mortality and morbidity in low-resource settings. The high prevalence of potentially preventable hypothermia today urges an investigation into why neonates still become hypothermic despite awareness of the problem and established thermal care guidelines. This study aimed to explore the gaps in knowledge and practices of neonatal thermal care among healthcare workers in low-resource settings. Methods: A cross-sectional, questionnaire-based survey was performed online among healthcare workers in low-resource settings. We applied a purposive and snowballing sampling method to recruit participants through a two-round international online survey. Questionnaires were developed using themes of neonatal thermal care extracted from existing neonatal care guidelines. Results: 55 neonatal care professionals participated in the first-round survey and 33 in the second. Almost all participants (n=44-54/55) acknowledged the importance of the WHO's warm chain to keep a neonate warm. However, fewer participants (n=34-46/55) responded to practice them. When asked about cold stress, defined as a condition in which neonates are below optimum environmental temperature and using more oxygen and energy while maintaining normal body temperature, 15 out of 55 participants answered that checking extremity temperatures by hand touch was useless. Some participants reported concern about the extremity temperature's inaccuracy compared with core temperature. Opinions and preferences for rewarming methods differed among participants, and so did the availability of warming equipment at their institutions. Conclusion: An inadequate understanding of cold stress underestimates the potential benefits of extremity temperatures and leads to missed opportunities for the timely prevention of hypothermia. The current thermal care guidelines fail to highlight the importance of monitoring cold stress and intervening before hypothermia occurs. Therefore, we urge introducing the concept of cold stress in any neonatal thermal care guidelines.</p

Clinical detection of 'cold stress' is overlooked: an online survey of healthcare workers to explore the gap in neonatal thermal care in low-resource settings

Background Neonatal hypothermia has been widely regarded as a major contributory factor to neonatal mortality and morbidity in low-resource settings. The high prevalence of potentially preventable hypothermia today urges an investigation into why neonates still become hypothermic despite awareness of the problem and established thermal care guidelines. This study aimed to explore the gaps in knowledge and practices of neonatal thermal care among healthcare workers in low-resource settings.Methods A cross-sectional, questionnaire-based survey was performed online among healthcare workers in low-resource settings. We applied a purposive and snowballing sampling method to recruit participants through a two-round international online survey. Questionnaires were developed using themes of neonatal thermal care extracted from existing neonatal care guidelines.Results 55 neonatal care professionals participated in the first-round survey and 33 in the second. Almost all participants (n=44-54/55) acknowledged the importance of the WHO's warm chain to keep a neonate warm. However, fewer participants (n=34-46/55) responded to practice them. When asked about cold stress, defined as a condition in which neonates are below optimum environmental temperature and using more oxygen and energy while maintaining normal body temperature, 15 out of 55 participants answered that checking extremity temperatures by hand touch was useless. Some participants reported concern about the extremity temperature's inaccuracy compared with core temperature. Opinions and preferences for rewarrning methods differed among participants, and so did the availability of warming equipment at their institutions.Conclusion An inadequate understanding of cold stress underestimates the potential benefits of extremity temperatures and leads to missed opportunities for the timely prevention of hypothermia. The current thermal care guidelines fail to highlight the importance of monitoring cold stress and intervening before hypothermia occurs. Therefore, we urge introducing the concept of cold stress in any neonatal thermal care guidelines.VD

The emergence of a graduate dental profession, 1858-1957

SIGLEAvailable from British Library Document Supply Centre-DSC:DXN027337 / BLDSC - British Library Document Supply CentreGBUnited Kingdo