In this section
Note: This guideline is currently under review.
Definition of Terms
Temperature management is a significant area of clinical practice particularly within paediatric nursing. Maintaining a constant body temperature is important and especially so in the neonatal population. Hypothermia and hyperthermia should be avoided as they can have severe adverse outcomes, increasing morbidity and mortality. Maintaining correct body temperature maximizes metabolic efficiency, decreases oxygen use, protects enzyme function and to decrease caloric expenditure.
To provide health care staff with information that enables them to manage temperature management in patients at the Royal Children’s Hospital.
Thermoregulation: The ability to balance heat production and heat loss in order to maintain body temperature within a certain “normal” range.Neutral thermal environment (NTE): narrow range of environmental temperature in which a person is able to maintain a neutral thermal temperature. A neutral thermal temperature is the body temperature at which an individual’s oxygen and energy consumption is minimised.
Temperature 37.2 – 38.0°C - Temperature > 38.0° C- Hypothermia: Body’s core temperature drops below that required for normal metabolism and body functions Neonate- a temperature <36.5 ºC Infant/child- a temperature <36 ºC Link to Onc – febrile neutropaenia CPGHyperthermia: Is an elevated body temperature due to failed thermoregulation that occurs when the body produces or absorbs more heat than it can dissipate. Hyperthermia differs from fever in the mechanism that causes the elevated body temperature. Mild hyperthermia -a temperature>37.5 ºC Extreme hyperthermia – a temperature > 38.8 ºCLink to fever in the Peadiatric patient CPG
Heat Stroke: thermoregulation is overwhelmed by a combination of excessive metabolic production of heat (exertion), excessive environmental heat and insufficient or impaired heat loss. This results in an abnormally high body temperature
Neonate: an infant that is up to 28 days corrected post term (e.g. an infant born at 34 weeks gestation and is 8 weeks old is 14 days corrected post term).
Non shivering thermogenesis: The primary source of heat production in the neonate. It is the production of heat by metabolism of brown fat Brown fat (deposited after 28 weeks gestation principally around the scapulae, kidneys, adrenals, neck and axilla) is a thermogenic organ unique neonates Methods of heat loss:
Radiant warming cots are designed to provide thermal stability to infants while allowing direct observation. These cots can be operated in servo control mode (the heating elements turn on and off according to measured changes in the infant’s skin temperature) or manual control (the heater is set to a constant power level).
Isolette: The trademark name for an autonomous incubator unit that provides a controlled heat, humidity and oxygen microenvironment for the isolation and care of premature and low birth weight neonates, and infants. The device is made of a clear plastic material and has a large door and smaller portholes for easy access to the infant with a minimum of heat and oxygen loss. A servo control mechanism can be used to constantly monitor the infant’s temperature and control the heat within the unit.
Temperature should be measured on admission and as per care plan (3-4 hourly for neonates) unless the temperature falls outside the normal limits- then it should be measured hourly till back within normal limits (link to Febrile Child CPG)Method of taking temperature:
(Refer to manufacturer’s instructions for correct use of thermometers)
Temperature may also be monitored in specialty areas e.g theatre, PICU, by the following methods
If using a radiant warmer, ensure the following:
If using an incubator, refer to Thermoregulation in the Preterm Infant guideline or Isolette use in Paediatric Wards RCH procedure.
For peri-operative management refer to peri-operative services
The neonate’s initial response to a cold environment is to constrict superficial blood vessels to minimize transfer of heat from the core to the surface of the body. Superficial vasoconstriction causes the mottled appearance of the skin. If the neonate is not warmed then cold stress can occur.Cold stress may result in:
May result in:
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Please remember to read the disclaimer.
The development of this nursing guideline was coordinated by Trudy Holton, Clinical Nurse Educator, Butterfly Ward, and approved by the Nursing Clinical Effectiveness Committee. Updated September 2014.