Neonatal Normothermia: Do We Have It Covered?Donna Harris, BA, RTT-NPS, RCP and Nicole Weaver, BSN, RNC, RN III

Cone Health System-Women’s Hospital

Neonatal Intensive Care Unit

Introduction

Hypothermia causes a multitude of physiological changes that

could trigger hypoglycemia, metabolic acidosis, peripheral

vasoconstriction and a host of other complications. To prevent

hypothermia in the neonatal population, the environment can

be managed by increasing delivery room temperature,

warming mattresses, skin-to-skin contact, and applying the

Thermoflect hat immediately following delivery. The focus of

our study was to determine if Thermoflect hats improved

NICU admission temperatures in different gestational ages,

from very low birth weight to term infants.Training Program Components

References:

InSoll, R. F. (2008). Heat loss prevention in neonates. J

Perinatal Journal of Perinatology, 28. DOI: 1038jp.2008.51

McCall E.M., Alderdice F., Halliday, H.L., Jenkins, J.G.,

Vohra, S. Interventions to prevent hypothermia at birth in

preterm and/or low birthweight infants. Conchrane Database

of Systematic Reviews 2010, Issue 3. Art. No.: CD004210.

DOI: 10.1002/14651858. CD004210.pub4.

Thermoflect heat reflective technology prevents hypothermia.

(n.d.). Retrieved June 24, 2016, from http://Thermoflect.com/

Singh, A., Duckett, J., Newton, T., & Watkinson, M. (2009). Improving

neonatal unit admission temperatures in preterm babies: Exothermic

mattresses, polythene bags or a traditional approach?

Journal of Perinatology, 30(1), 45-49. doi:10.1038/jp.2009.94

Knobel, R. B., Wimmer, J. E., & Holbert, D. (2005). Heat Loss Prevention for Preterm Infants in

the Delivery Room . Journal of Perinatology, 25(5), 304-308. doi:10.1038/sj.jp.7211289

Bhatt, D. R., White, R., Martin, G., Marter, L. J., Finer, N., Goldsmith, J. P., Ramanathan, R. (2007).

Transitional hypothermia in preterm newborns. Journal of Perinatology, 27.

doi:10.1038/sj.jp.7211842

AbstractMaintaining normothermia (36.5 – 37.5 °C) in the neonatal intensive

care population is vital, resulting in decreased mortality and

morbidity. Several interventions are already common practice in the

delivery room to avoid hypothermia in newborns. These include

chemical warming mattresses, increased delivery room temperature,

knit hats and pre-warmed blankets. Even with these interventions in

place hypothermia is still a concern. Due to a lack of published

evidence about Thermoflect infant caps, further research was

required to investigate the effectiveness of this technology.

This retrospective, non-randomized historically controlled study

included using quantitative data of 330 infants admitted to the NICU

over a six (6) month time span at Women’s Hospital in Greensboro,

North Carolina. A baseline of temperature data was collected for

three (3) months before the Thermoflect caps were put into place and

for three (3) months while the Thermoflect caps were used. The

study population was broken down into four (4) gestational

subgroups: 23-27 weeks, 28-32 weeks, 33-36 weeks, and 37+ weeks.

The mean temperatures were calculated for each subgroup to

compare temperatures before and after the use of Thermoflect caps.

Results across the study saw nominal increases in body temperature.

The older the gestational age the better the result. In the best case an

average increase of 0.18°C was seen. In this study the majority of the

subjects were normothermic upon admission. Additional studies are

warranted to discover if the use of Thermoflect caps in conjunction

with other interventions would lead to substantial increases in body

temperature.

Methods Temperatures were recorded on admission to the NICU

starting in September 2015 prior to implementation of

Thermoflect hats giving us 3 months of data.

Thermoflect hat use initiated December 15, 2015.

Data was collected for 3 months after initiation of the

Thermoflect hats.

After data was collected, the neonates were grouped

according to their gestational age to establish similar body

surface area comparisons.

Mean temperatures of each gestational group, both before

and after initiation of the Thermoflect hat, are

demonstrated on the charts included.

Conclusion

The results of our study indicate minimal mean temperature

increases across gestational groups after implementation of the

Thermoflect hats.

While we expected to find a greater mean temperature increase,

especially in the 23-27 week gestation group, due to immature

thermoregulatory mechanisms and a large surface area to body

weight ratio, it increased by a minimal 0.01 degree Celsius. The

patient sample size for this gestation was only twenty-three patients

over a 6 month span. The impact of hypothermia prevention

measures, that were in place prior to the study, included increased

delivery room temperature and chemical warming mattresses. The

introduction of the Thermoflect hats contributed to a minimal gain

in mean NICU admission temperatures across gestational groups.

36.67

36.6236.64

36.87

36.6836.66

36.72

37.05

36.4

36.5

36.6

36.7

36.8

36.9

37

37.1

23-27 28-32 33-36 37+

Average Temp Before and After Thermoflect Hat

Avg Temp Before Avg Temp After

Before After

23-27 Weeks Average Temp: 36.67 23-27 Weeks Average Temp: 36.68

28-32 Weeks Average Temp: 36.62 28-32 Weeks Average Temp: 36.66

33-36 Weeks Average Temp: 36.64 33-36 Weeks Average Temp: 36.72

37+ Weeks Average Temp: 36.87 37+ Weeks Average Temp: 37.05