Thermoregulation

[Guest jensmithrn]

What weight do you wean from isolettes? Do you use gestational age to factor when to wean or just weight?

[rokovich]

In my experience, weaning an infant from the isolette is not a function or weight or gestational age. Rather, it is accomplished by observing the infant's requirement for external thermoregulatory support. As the infant's requirement for external warmth decreases, the environmental temperature of the isolette will decrease. When it drops below 30 degees C, the infant may be ready for an open crib trial. You must also factor in the infant's growth and ability to tolerate the increased visual and auditory stimulation that comes from taking them out of the isolette. If they aren't growing adequately, or are excessively agitated, you may want to leave them in the protected environment of the isolette to decrease their energy expenditure and promote improved growth.

That said, there is an increasing body of evidence that infant nurturing leads to improved growth and development. It is important to encourage human contact and mother/infant interaction as soon as the infant is stable enough to tolerate the stimulation. This may mean taking them from the isolette for feeding, kangaroo care, etc. even before they are physiologically ready to maintain their own body temp.

There is my two cents...hope it helps.

[Guest]

..we use weight, plus how the babe copes with being out of the incubator for cuddles etc, as a guideline. Generally a weight above 1.8kg, in an infant who is stable is tried in an open cot. Sometimes they need a heated matress undeneath, but usually with hats, blankets etc..they maintain a stable temp.

[Skysurfer]

Hello to everybody,

We start to use a humidity of 85% for the first 7 days of life. Then, we try to reduce the humidity during the following 21 days to 70% similar to the maturation of the skin, which begins at birth regardless of the gestational age. After the child reaches the age of 3 Weeks, we reduce the humidity further to 60%. According to his/her stability, the infant can be dressed and once it is dressed we atart to use 50% humidity. The Temperature is controlled by the isolette in the skin (auto-) mode. When the Baby reaches 1200 - 1400grams, we place him/her in a bed which is heated under the matrass to help the infant maintain a stable core temperature 36.5°- 37.5°C. We have a written policy which shows every step according to weight and the age and if you are interesten i can mail it to you privately.

Hope that helps Norbert

[Skysurfer]

I just have attached our spreadsheet "Tuning of the Humidification (Isolette) in relation to the Gestational Age and Days of live".

The temperature taken at the central part of the body is directly dependent upon the peripheral temperature until the peripheral temp. reaches a “higher” level around 35.5-36.5°C. Then, the “central” temperature reflects a “real” core temperature, because the core temp. can remain stable even though the child is in a cold stress with heightened warmth production….

That`s why the temp. taken centrally most likely reflects the core temperature when the child has a warm periphery. So from my point of view, the Temperature gradient method, where you have to use 2 temp. probes is the best method available to keep the infants in a thermal neutral environment.

Hope that helps

Norbert

Temp&Feuchte.doc

[nishantat]

can you please tell me about your practice about placing the skin temperature probe, what site is preferable on abdomen?

[Guest cocoguawa]

In our NICU (3 LEVEL) we use a temperature probe in the axilar region (we consider this as central temp) and other one in the foot plant as peripherical temp. We don´t use any temperature in the abdominal or hepatic region.

[Guest cocoguawa]

The Iberoamerican Neonatology Society (Sociedad Iberoamericana de neonatología SIBEN) has released a clinical guide about thermoregulation, is in Spanish, (but goole translator is wonderful :-D)

You can download it here