Use of selected warming devices to maintain a thermal neutral environment is implemented by the registered nurse (RN) or licensed practical nurse (LPN) with an order from a healthcare prescriber. Follow institutional protocols.
The infant’s temperature is maintained within a specific environmental range, called the thermal neutral zone (TNZ), in which the rates of oxygen consumption and metabolism are minimal and internal body temperature is maintained because of thermal balance. To achieve a thermal neutral environment, regulate warming device to an abdominal wall, flank, or axilla temperature of 97.7°F (36.5°C) or as ordered by healthcare prescriber.
All newborns have their temperature assessed hourly and as needed for the first 4 hours of life.
All infants and children have their temperature assessed as per their acuity level and standard of the unit or institution (see Chapter 123).
Temperature measurement device (see Chapter 123 for types of temperature measurement devices)
Blankets
Head covers
Booties
Radiant warmer
Servo-control temperature probe
Double-walled isolette (Use of porthole sleeves, when available, decreases the amount of ambient heat loss.)
Chemically heated mattress
Linen to cover mattress
Heat lamp
Yardstick or tape measure
Plexiglas heat shield
Plastic wrap
Polyethylene/polyurethane bag
Oxygen tubing
Oxygen flowmeter
Humidification device
Educate the family regarding the importance of maintaining the infant’s body temperature. Remind the family of the importance of following the guidelines of the American Academy of Pediatrics “Safe Sleep” campaign and that pillows, comforters, and quilts should not be placed in the crib as a means to warm the child.
Discuss the measures that will be used to maintain the infant in a thermal neutral environment:
Explanation of how infant loses heat and tries to maintain heat (Chart 76-1)
Measures used to prevent heat loss
Measures used to provide heat to the infant (heat production)
Manner in which the family can assist with the infant’s care while maintaining the infant’s temperature
Explanation of all equipment to be used to assist in warming the infant
Measures to be used to monitor the infant’s temperature
How to provide skin-to-skin contact (kangaroo care) to the infant
Prewarm isolette or warmer in anticipation for admission of the infant. If delivery of an extremely low-birth-weight infant is anticipated, set delivery room temperature at the appropriate temperature as determined by the delivery room standards; 80°F (26.7°C) is suggested.


Maintaining a Thermal Neutral Environment
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