Use of selected warming devices to maintain the child’s temperature may be implemented by the registered nurse (RN) or licensed practical nurse (LPN). Use of some warming devices require a healthcare prescribers orders; follow institutional protocols.
Use of hypothermia blanket may only be implemented by the RN or LPN by the order of a healthcare prescriber.
Child’s temperature is maintained between 97.7°F and 99.5°F (36.5°C and 37.5°C).
Preterm infant’s temperature is maintained between 97.3°F and 98.9°F (36.3°C and 36.9°C).
Hypothermia is considered to be a core body temperature less than 97.7°F (36.5°C) or a skin temperature less than 96.8°F (36°C) and may occur in premature infants and in children with intracranial birth injury, shock, or critical illness or in those under heavy sedation.
All preterm infants are maintained under a radiant warmer or in an isolette until they are able to maintain their body temperature within normal ranges without adjunct therapy.
Warming measures are initiated when a child’s core temperature is less than or equal to 97.2°F (36.2°C).
Child’s temperature is closely monitored during warming measures and until it has returned to within normal parameters.
Profoundly hypothermic children are placed on a cardiorespiratory monitor.
Temperature measurement device (see Chapter 123 for types of temperature measurement devices)
Servo temperature probe
Double-walled isolette (use of porthole sleeves, when available, decreases the amount of ambient heat loss)
Servo temperature probe
Chemically heated mattress
Linen to cover mattress
Electronic warming blanket
Hypothermia machine with thermometer probe
Distilled water (to fill machine if needed)
Forced-air warming blanket
Linen to cover warming blanket
Assess child’s clinical history and related symptoms to determine reasons for hypothermia:
Injury to or disease of the hypothalamus or pituitary gland, which can produce changes in the child’s ability to thermoregulate
Lack of clothing or covers
Cold environment (e.g., crib placed near a window or air-conditioning vent)
Diagnosis related or recent surgery
Wet linen and covers
Pooling of secretions under the body
Ventilation with cold, dry oxygen
Failure to thrive or starvation
Explain to the child and the family what you will be doing to moderate or alter the child’s temperature
and make the child more comfortable. Include the following in discussion:
Measures used to provide warmth to the child
Manner in which the family can assist with the child’s care while maintaining the child’s temperature such as swaddling
Explanation of all equipment to be used to assist in warming the child
Measures to be used to monitor the child’s temperature
Providing skin-to-skin contact (“kangaroo care”) to the infant
Encourage the family to be present in the room and to participate in measures to warm the child.
Use diversionary techniques with the child if needed to ensure their cooperation while undergoing warming procedures.