Steps

Rationale/Points of Emphasis

1 Perform hand hygiene; don protective apparel (gown and gloves) for care of infant immediately after delivery. Perform hand hygiene after each contact with the infant and before initiating new contact with infant.

Reduces transmission of microorganisms. Protects healthcare provider from exposure to blood and body fluids.

2 Place infant under warming source (on prewarmed warmer or isolette) after birth. Dry infant and remove wet linens. Provide warmed blankets and hat for warmth.

Decreases evaporative heat loss and decreases loss from the head, which is an infant’s largest heat-losing body surface.

3 Determine newborn’s temperature while under warming source.

3a Place servo-control temperature probe over abdominal area, flank, or axilla using foil protective cover; do not place probe where infant will lie on the sensor.

The probe must be in good contact with the skin so that it does not cause false high or low temperatures, thus causing the heating element to react and adversely affect the infant’s temperature. Probe placement on the abdomen, flank, or axilla show no significant temperature differences (Schafer, Boogaart, Johnson, et al., 2014).

3b Correlate probe readout with infant’s temperature when recording vital signs.

Ensures correct patient data are being observed and collected.

caREminder

Do not place probe over stomach area if infant is being fed enterally because the probe will sense the feeding temperature and therefore fluctuate the environment accordingly.

4 Assess temperature hourly for the first 4 hours of life and then as indicated by infant’s acuity level and institutional policy; see Appendix A: Reference Ranges for Vital Sign Measurements for normal ranges. Refer to Chapter 123 for methods to assess temperature.

Ensures that deviation from normal is detected promptly.

5 Offer family the option of skin-to-skin contact, if infant is stable.

Skin-to-skin contact encourages warmth from convection with family member’s body temperature.

6 Give first bath after the infant’s temperature has stabilized in the normal range (98.2°F-99.8°F or 36.8°C-37.7°C axillary) and when appropriate care is taken to support thermal stability (see Chapter 15 ).

Prevents hypothermia that can increase oxygen consumption and respiratory distress.

7a Assess infant. If stable, clothe infant, put on head covering, bundle in blanket, and move infant to open crib for ongoing observations or transfer to mother or father to hold.

Stability is determined by normal vital signs and no signs of respiratory distress. Easy visualization of infant’s chest will aid in prompt detection of increasing respiratory distress. Early transfer to the mother or father promotes parent-infant bonding.

caREminder

Typically, healthy infants who weigh more than 2,300 g can maintain their temperature when covered, as above, in an open crib.

7b Continue to monitor temperature per institutional policy. To prevent exposure and chilling, keep neonate wrapped in a lightweight blanket and accomplish care quickly in a draft-free, warm environment.

Prevents further exposure to cold environment.

8 Provide ongoing warming measures as needed (Figure 76-1).

Prevents hypothermia, which can increase oxygen consumption and respiratory distress. Warming measures are selected on the basis of infant’s temperature, age (premature vs. term), diagnosis, and the resources available.

Figure 76-1 Various methods help newborns maintain thermoregulation: (A) isolette, (B) radiant warmer, (C) plastic wrap, or (D) combination unit, radiant warmer, and isolette.

8a If unable to maintain temperature within normal range and if signs of respiratory distress or other signs need to be closely observed, keep the infant under radiant warmer or move to prewarmed incubator or isolette.

If infant’s axillary temperature is below 97.2°F (36.2°C), rewarming should be initiated. The process should be gradual to prevent the possibility of hyperthermia. Servo-control mode is required for slow rewarming of infant. When the new skin temperature is reached, the air temperature is increased in hourly increments of 1.0°C until the desired skin temperature is reached and infant’s temperature is stable.

8b Follow procedures in Chapter 124 for use of the following warming devices:

• Radiant warmer and isolette

• Chemically heated mattress

• Heat lamp

Ensures that environmental temperature is individualized as appropriate for the infant. Ensures that deviations from normal are detected promptly.

Place warming device and infant in a draft-free environment, out of direct sunlight, to decrease temperature fluctuations due to convection and radiation.

8c For use of plastic wrap as a warming device:

• Stretch wrap over the infant across the plastic sides of radiant warmer.

• Do not place wrap directly on infant’s skin.

Provides barrier to decrease heat loss by convection or evaporation. Contact with infant’s skin may cause maceration or burning.

8d For use of polyethylene/polyurethane bag to prevent heat loss in very low-birth-weight infants:

• After delivery and placement on warmer, immediately place infant in bag up to neck before drying; dry infant’s head and cover with hat.

Decreases evaporative heat loss. If needed, resuscitation can be performed with infant in bag.

8e For use of Plexiglas heat shield as a warming device:

• Place heat shield over infant in incubator or isolette. Do not use when the infant is under radiant warmer.

Decreases radiant heat loss. Under the radiant warmer, the heat shield blocks the infrared heat from reaching the infant.

8f For use of warmed inspired air to aid in thermoregulation:

• Follow procedure for oxygen administration (see Chapter 80 ) to provide warm, humidified, inspired air if infant requires supplemental oxygen.

Provides additional measures to decrease evaporative heat loss and insensible heat loss.

9 Continue to monitor temperature per institutional policy. Continue warming measures as needed.

Provides ongoing assessment and reevaluation of interventions.