DO NOT USE FOR CLINICAL PRACTICE
Please use current guidelines available on the UHNM intranet for patient treatment
Please use current guidelines available on the UHNM intranet for patient treatment
This guideline does not apply to babies receiving therapeutic hypothermia
MEASUREMENT AND RECORDING
- Use axillary route
- Measure temperature on admission, within ≤60 min of birth, then
- Hourly until stable, then 3–4 hrly
- more frequently if required due to clinical condition
- 6-hrly when baby stable and on 3-hrly feeds
- Babies with poor perfusion (or on medical request) – monitor core peripheral temperature difference continuously using temperature probes on chest and foot
- difference of >2°C suggestive of poor perfusion
TEMPERATURE RANGES
- Normal: 36.5–37.5°C
- Hypothermia: <36.5°C
- Low grade fever: 37.6–37.9°C
- Fever: ≥38°C
ASSESSMENT
- Hypothermia, fever and temperature instability can be signs of serious illness
- If baby unwell, irrespective of body temperature, notify medical staff/ANNP
- Beware of unusual temperature behaviours e.g.:
- hypothermia in term baby
- fever in preterm baby
HYPOTHERMIA
Follow BAPM QI Toolkit for prevention of hypothermia in preterm babies − https://www.bapm.org/pages/105-normothermia-toolkit
Risks and consequences
- Babies <32 weeks’ gestation, low-birth-weight, small-for-dates and sick babies are at particular risk of hypothermia
- Adverse effects associated with hypothermia include:
- hypoglycaemia
- hypoxia and metabolic acidosis
- respiratory distress and chronic lung disease
- necrotising enterocolitis
- intraventricular haemorrhage
- late onset sepsis
- death
PREVENTION
Delivery suite
- Keep room 23–28°C and free from draughts, especially when delivery imminent
- aim for room temperature on the higher side for all premature babies (particularly IUGR)
- Pre-warm resuscitaire and towels with heater at 100%
Babies <32 weeks
- Place baby on resuscitaire, dry head only
- place baby’s body in plastic bag
- place hat on baby’s head
- Take temperature before moving baby to NNU
- Transfer to NNU with suitable thermal support
Other babies
- Use pre-warmed towels. Dry immediately, discard towel and wrap in another towel and blanket
- Ensure room warm enough to enable skin-to-skin contact and early breastfeeding
- Cover exposed skin with warm blanket
- Avoid giving bath immediately after birth
Neonatal unit
- Keep at 24–25°C to avoid cooling from radiant heat loss, and ‛misting’ (condensation) in incubators
- Keep incubators and cots away from windows to prevent radiation heat loss
- Nurse babies requiring intensive care in pre-warmed incubator
- For very premature babies, use humidification in incubator
- If respiratory support e.g. high flow oxygen therapy, CPAP or ventilation anticipated ensure humidifiers are turned on and set temperature of 37°C achieved
- Do not leave incubator portals open for longer than necessary
- Avoid excessive wrapping/clothing of babies in cots
Incubator temperature during first 3 days
Birth weight (g) | Incubator temperature (°C) |
1000 | 35 |
1500 | 34 |
2000 | 33.5 |
2500 | 33.2 |
3000 | 33 |
4000 | 32.5 |
- Babies <1000 g may require higher temperatures, occasionally >37°C
- If baby’s temperature remains within normal limits for 24 hr, reduce incubator temperature according to baby’s needs
- When baby’s weight reaches approximately 1600 g, transfer to open cot
Rainout may occur if the difference between temperature in incubator and room temperature is >5°C: ensure room temperature kept at 24–25°C
Babies not at risk of hypothermia
- If not requiring observation of respiratory status or invasive procedures, babies may be dressed, wrapped and placed in a cot
Take care not to overheat babies. Aim for 36.5–37.5°C
EVALUATION AND MANAGEMENT OF TEMPERATURE INSTABILITY
MANAGEMENT OF HYPOTHERMIA
- Mild hypothermia can be managed with the addition of:
- hat
- heated mattress
- If baby’s temperature <36.0°C consider:
- use of incubator, if available
- increasing humidity, if appropriate for gestational age
- bubble wrap
- skin-to-skin
- Recheck temperature in 1 hr
- Baby to be reviewed by medical team
REWARMING OF HYPOTHERMIC BABIES
- Rewarm in incubator
- ≥1200 g, rewarm at 1°C/hr
- <1200 g, rewarm more slowly
CAUTION DURING USE OF TRANSWARMERS
- Heated pads (Transwarmer) should not be used if another heat source (incubator heater, radiant heater, heated mattress etc.) is already in use
- If units choose to continue to use Transwarmers in conjunction with radiant heat to prevent newborn hypothermia, strict vigilance must be given to:
- ensuring skin integrity
- avoiding hyperthermia by continuous temperature monitoring
- limiting duration of use