Thermoregulation In Newborns Research Articles

Determining Consensus Alignment and Barriers of Neonatal Thermal Management in Nepal Using a Modified Delphi Process.

Objective. Neonatal hypothermia is a worldwide health burden with an incidence ranging from 32% to 85% in hospitals and 11% to 92% in homebirths. It is prevalent in Nepal and associated with increased morbidity and mortality. The study objective was to identify key practice standards of newborn thermal management in Nepal. Methods. Our subjects included 6 lead newborn physicians from major birthing centers in Kathmandu. A modified Delphi process was used to identify the top 5 key practice standards for newborn thermoregulation in the hospital, health post, and home, compiled from 14 World Health Organization recommended practices. Results. There was consensus in all ranked practices except using radiant heat sources in the hospital and performing Kangaroo Mother Care in the homebirths. Comments conveyed that interventions during the immediate delivery phase were most impactful and feasible. Conclusion. Nepali physicians prioritized thermoregulatory practices during the immediate resuscitation period over the post-resuscitation period.

Hats Off for Full-Term Healthy Newborns: No Benefits for Thermoregulation.

Hyperthermia is a known risk for sudden unexpected infant death. The practice of hat placement at birth to prevent transient hypothermia may not be necessary and sets an early standard for clothing infants that may lead to hyperthermia postnatally. To examine the elimination of hats on thermoregulation (eg, hypothermia, <97.6°F) in full-term newborns with no abnormalities within 24 hours of birth. In 2018, an institution guideline discontinued the use of hats at birth. Subsequently, newborn body temperatures were respectively extracted from electronic health records and data were compared from 482 infants (>38 weeks' gestation and newborn birth weight >2500 g) prior to ( n = 257) and following ( n = 225) the practice change. Body temperatures prior to and after the practice change to eliminate hats use were compared. No statistically significant difference was observed: (1) in the proportion of infants experiencing hypothermia with or without hat use, respectively, 23.7% compared with 31.1% ( P = .09) and (2) in the odds of an infant experiencing hypothermia when adjusting for relevant covariates (odds ratio = 1.44; 95% confidence interval 0.89-2.32; P = .14). Our findings demonstrate that the use of hats on infants at birth had no measurable impact on newborn thermoregulation.

Penerapan Pemakaian Skin Wrap dalam Pengaturan Suhu Tubuh Bayi Baru Lahir di RS Awal Bros Grup

Newborns can experience hypothermia shortly after birth, hypothermia occurs through several mechanisms, which are related to the body's ability to balance heat production and heat loss. Failure caused by a decrease in the body temperature of the baby born falls by about 0.30C per minute. To avoid hypothermia, several ways can be done, including by using skin wrap. Skin wrap is a plastic bag to reduce heat loss due to evaporation so that it can easily increase the baby's temperature. The method of using skin wrap can be used to prevent hypothermia in neonates, both premature and not. Hypothermia in infants can worsen the condition of babies who lose heat after birth. Providing education and outreach regarding the application of skin wraps for newborns is carried out so that all nurses understand the importance of implementing this in order to maintain thermoregulation in newborns. Education was carried out for all nurses in the Awal Bros Group Hospital environment on May 25 2023 with a total of 94 participants which was carried out online with zoom.

Effects of incubation temperature on development, morphology, and thermal physiology of the emerging Neotropical lizard model organism Tropidurus torquatus

Incubation temperature is among the main phenotypic trait variation drivers studied since the developmental trajectory of oviparous animals is directly affected by environmental conditions. In the last decades, global warming predictions have aroused interest in understanding its impacts on biodiversity. It is predicted that the effects of direct warming will be exacerbated by other anthropogenic factors, such as microclimatic edge effects. Although the Brazilian Cerrado biome is one of the most affected by these issues, little is known about the aforementioned effects on its biodiversity. Therefore, the aim of our study is to investigate the influence of incubation temperature on developmental parameters, morphology and thermal physiology traits of the collared lizard (Tropidurus torquatus). Furthermore, we discuss our findings regarding lizard developmental biology and the climate change paradigm. Therefore, we incubated T. torquatus eggs under five temperature regimes ranging from artificial nest temperature (28.7 °C) to 35.0 °C. We found that elevated incubation temperatures affect several investigated traits: egg mass gain is positively affected, without any influence in newborn mass; incubation period is broadly reduced with temperature increase; survival rate is negatively affected by temperature, constant 35.0 °C regime is confirmed as a lethal incubation temperature, and the sex ratio is affected at 30.0 °C, with a prevailing outbreak of females. Increased incubation temperature also affects body and head size but has no effect on limb size. Newborn thermoregulation and the critical thermal maximum (CTmax) are not affected by incubation temperature. On the other hand, basal body temperature (Tbb) and the critical thermal minimum (CTmin) were positively affected. Thermal physiology was also affected by age, with newborns differing from adults for all analyzed thermal traits. Our findings indicate that future modifications in incubation temperature regimes at nesting sites caused by warming may affect several features of the development, morphology, and thermal physiology of newborns of this species. Laboratory experiments have pointed to possible drastic effects of warming on lizard survival rates, also affecting aspects of its natural history and population distribution. Moreover, in addition to being more vulnerable than adults in aspects such as predation and feeding, T. torquatus newborns are also more vulnerable regarding thermal physiological traits.

Accuracy of the defining characteristics of the nursing diagnosis: Ineffective thermoregulation in newborns

ObjectiveTo identify the measures of accuracy for defining characteristics of the nursing diagnosis: Ineffective thermoregulation in newborns. MethodDiagnostic accuracy study with cross-sectional design performed in medium and high-risk maternity units, located in Fortaleza city/Brazil. A total of 216 newborns were evaluated to identify the defining characteristics of the diagnosis under study. The measures of accuracy for defining characteristics were obtained from a latent class model with random effects for the calculation of sensitivity and specificity values. ResultsThe characteristics of increased respiratory rate and warm skin to the touch had higher sensitivity values (99.9%) and lower specificity (79 and 75%) and the characteristics of body temperature fluctuations above and below the normal parameters and hypertension had the highest specificity (80.4 and 100%, respectively). ConclusionThe characteristic fluctuation of the body temperature above and below the normal parameters may be better to confirm the diagnosis, having presented a higher specificity value.

Effects of soybean oil inclusion in the pre-lambing diet on udder size, colostrum secretion, and offspring thermoregulation and growth in hair-breed ewes

Dietary inclusion of vegetable oils in pregnant females is beneficial to improve offspring development and growth during its pre- and post-natal life because these oils are rich in polyunsaturated fatty acids. Excessive oil intake can result in contrary effects. To evaluate the effects of dietary inclusion level of soybean oil (SBO) during the last third of gestation on udder size, production and composition of colostrum, newborn thermoregulation, and lamb growth during the pre-weaning period, 30 Katahdin x Pelibuey multiparous ewes (Body weight [BW]= 50.8±0.38kg, body condition score [BCS]= 3.02±0.04 units) were assigned under a randomized complete block design to 1 of 3 treatments, which consisted in isoenergetic and isoprotein diets containing 0, 30 or 60g of SBO/kg DM. Diets were offered from d 100 of pregnancy to lambing. All measurements were collected around lambing and first 60 d post-lambing. There was no treatment x time interaction for BW, BCS, production and chemical composition of colostrum, and offspring thermoregulation. Maternal BW and BCS as well as chemical composition were not affected by SBO. Weight and volume of colostrum linearly increased (P = 0.01) as the dietary level of SBO increased from 0 to 60g/kg DM. Rectal temperature in newborn lambs was not affected by SBO, but eye and muzzle temperatures, as well as coat temperatures from ear, muzzle, loin, right flank, belly, rump, shoulder and leg linearly increased (P < 0.01) with increasing the SBO level in the pre-lambing diet. Treatment x time interaction affected (P ≤ 0.05) udder traits, being higher udder volume and circumference in ewes fed 60g of SBO/kg DM than in control during the pre-lambing period. At birth, morphometric measures in lambs were unaffected by the treatment x sex interaction or main factors, while male lambs from ewes fed 60g of SBO were the heaviest (P < 0.01) compared to any of the other treatments. Pre-weaning daily weight gain and weight at weaning showed a quadratic effect (P ≤ 0.05) with increasing levels of SBO. In general, results suggest that dietary inclusion of 60g of SBO/kg DM during the last third of pregnancy in hair ewes could be an optimal dose to simultaneously increase colostrum production, udder size pre-lambing, newborn thermoregulation and pre-weaning growth of their lambs.

Brown adipose tissue: a potential target in the fight against obesity and the metabolic syndrome.

BAT (brown adipose tissue) is the main site of thermogenesis in mammals. It is essential to ensure thermoregulation in newborns. It is also found in (some) adult humans. Its capacity to oxidize fatty acids and glucose without ATP production contributes to energy expenditure and glucose homoeostasis. Brown fat activation has thus emerged as an attractive therapeutic target for the treatment of obesity and the metabolic syndrome. In the present review, we integrate the recent advances on the metabolic role of BAT and its relation with other tissues as well as its potential contribution to fighting obesity and the metabolic syndrome.

Implementing a Birth Kangaroo Care Policy in Labor and Delivery: Bringing Evidence‐Based Practice to the Bedside

Poster Presentation Purpose for the Program The birth of an infant is one of the most meaningful experiences in a woman's life. Birth kangaroo care (BKC), early skin‐to‐skin contact between mother and infant from birth until first breastfeeding is accomplished, is recommended by the American Academy of Pediatrics and many other organizations. Research shows that BKC provides physiologic and emotional benefits for both mother and infant. Newborn thermoregulation and blood glucose stabilization are enhanced when infants are kept skin‐to‐skin with their mothers. They cry less and breastfeed easier. Mothers report more confidence, stronger attachment, and distraction from discomfort when they hold their infants immediately after birth. Yet, despite the evidence, most hospitals still practice routine separation of mothers and infants. How can a team of nurses create a policy and change the culture of childbirth in a community hospital? Proposed Change Making BKC part of the labor and delivery unit's normal routine requires more than writing a policy. It requires using change theory and evidence‐based research to bridge the gaps between “the way we've always done it” and family‐centered maternity care. This community hospital wanted to make skin‐to‐skin contact between mothers and infants part of their normal routine for vaginal and cesarean births. Implementation, Outcomes, and Evaluation By using evidence‐based research, a team of nurses wrote a policy that made BKC the standard of care for vaginal and cesarean births. Key issues addressed in the policy include management of the third stage of labor while the mother maintains skin‐to‐skin contact with her infant; caring for the newborn (vital signs, medications, glucose monitoring, and bathing); time management; and providing BKC while caring for a patient who has had a cesarean delivery. In addition to logistics, change theories were used to deal with the resistance to change in practice and culture within the institution. Lewin's Change Theory and Roger's Diffusion of Innovation Theory were used to bring staff and physicians on board. While the policy was being implemented, management supported staff by ensuring ratios allowed nurses the time they needed as they adjusted to the change. Breastfeeding rates went up initially from 59% to 75%. Maternal satisfaction was enhanced as indicated from the positive letters, surveys, and in‐person feedback. Implications for Nursing Practice Cultural shift within the unit was facilitated with Lewin's concepts of unfreezing, moving, and refreezing and Roger's concepts of early adopters. Implementing BKC benefited the families served and staff were empowered by the process.

Evidence-Based Practices for the Fetal to Newborn Transition

Many common care practices during labor, birth, and the immediate postpartum period impact the fetal to neonatal transition, including medication used during labor, suctioning protocols, strategies to prevent heat loss, umbilical cord clamping, and use of 100% oxygen for resuscitation. Many of the care practices used to assess and manage a newborn immediately after birth have not proven efficacious. No definitive outcomes have been obtained from studies on maternal analgesia effects on the newborn. Although immediate cord clamping is common practice, recent evidence from large randomized, controlled trials suggests that delayed cord clamping may protect the infant against anemia. Skin-to-skin care of the newborn after birth is recommended as the mainstay of newborn thermoregulation and care. Routine suctioning of infants at birth was not been found to be beneficial. Neither amnioinfusion, suctioning of meconium-stained babies after the birth of the head, nor intubation and suctioning of vigorous infants prevents meconium aspiration syndrome. The use of 100% oxygen at birth to resuscitate a newborn causes increased oxidative stress and does not appear to offer benefits over room air. This review of evidence on newborn care practices reveals that more often than not, less intervention is better. The recommendations support a gentle, physiologic birth and family-centered care of the newborn.

A Research Program to Examine Evidenced-Based Practices in Newborn Thermoregulation

Background: Thermoregulation is a critical component of neonatal care. Practices surrounding thermoregulation have not been re-tested though the frontier of viability has markedly changed. Maintaining a neutral thermal environment (NTE) is one foundation of care for this population. There is no easy way to determine whether an infant is in his or her NTE. Rather clinicians have extrapolated data from historical studies that have determined the correlation between O2 consumption, rectal temperature, and skin temperature. These studies were conducted on infants that did not reflect the demographics of the infant population in modern NICUs. Less than 20 years ago, the survival for infant <1000 grams was a rare event. Hence, some of these data need to be re-examined to determine if practices surrounding temperature control are still valid and to determine if the methods of driving heater control algorithms are influenced by these demographic differences. Further, one should realize that approximately 50% of the nurseries in the world practice a baby-control philosophy to thermoregulation while others practice an air-control philosophy. Does the data show that one approach is better for the baby that the other?

A Research Program to Examine Evidenced-Based Practices in Newborn Thermoregulation

A Research Program to Examine Evidenced-Based Practices in Newborn Thermoregulation

A Research Program to Examine Evidenced-Based Practices in Newborn Thermoregulation

A Research Program to Examine Evidenced-Based Practices in Newborn Thermoregulation

A Newborn’s First Bath: When?

To determine the effects of early admission bathing on thermoregulation in newborns. Randomized, comparative study. A regional hospital providing primary and secondary newborn care. One hundred healthy, full-term newborns. Newborns in the investigational group with a minimum rectal temperature of 36.5 degrees C. were bathed after the newborn admission assessment examination was completed (M = 61.15 minutes of age), whereas newborns in the control group were bathed at the standard of 4 hours of age (M = 252.12 minutes of age). Rectal temperatures were measured using a Diatek thermometer. Rectal temperatures were recorded during the newborn admission assessment examination, immediately before bathing, immediately after bathing, 1 hour after bathing, and 2 hours after bathing. No significant differences (p < .05) in rectal temperatures, were found between the groups during the admission assessment examination, before bathing, immediately after bathing, 1 hour after bathing, or 2 hours after bathing. No significant differences were found between the groups in type of delivery, time of birth, gestational age, birth weight, Apgar scores at 1 and 5 minutes, air temperature, apical heart rate, or respiratory rate. Healthy, full-term newborns whose rectal temperatures are greater than 36.5 degrees C can be bathed immediately after the admission assessment examination.

Role of noradrenergic innervation of brown adipose tissue in thermoregulatory deficits following prenatal alcohol exposure.

The development of thermoregulation in newborns is delayed by prenatal alcohol exposure in an animal model of moderate maternal drinking. Newborn mammals generate heat primarily via nonshivering thermogenesis in brown adipose tissue (BAT), which is activated by the sympathetic nervous system. In this study, the effects of prenatal alcohol exposure on the development of the sympathetic innervation of BAT was investigated by assessing the concentration of norepinephrine (NE) in interscapular BAT. Pregnant dams were given either a liquid diet with 35% of the calories derived from alcohol, a liquid diet without alcohol to control for any effects of the liquid diet administration, or ad libitum food and water. Interscapular brown adipose tissue was excised from 5-, 10-, and 20-day-old male and female offspring. At 5 days of age, alcohol-exposed pups had significantly lower NE concentrations than did pups in either control group. However, 20-day-old alcohol-exposed pups had significantly higher NE concentrations than either control group. These results suggest a delay in the development of the sympathetic activation of BAT thermogenesis, followed by a compensatory overactivation. These findings may have important implications for understanding the mechanisms underlying thermoregulatory deficits seen after prenatal alcohol exposure. In addition, these results suggest that maternal alcohol consumption may increase the risk of sudden infant death syndrome, which has been linked to inappropriate BAT thermogenesis.

Understanding Thermoregulation in Newborns

For nurses to act responsibly in preventing cold stress in newborns, whether term or preterm, they must have a working knowledge of the physiology and the physics of thermodynamics involved in the body and in its reaction to environmental variables. Knowing sufficiently what principles are involved, one can intelligently anticipate problems and implement the appropriate nursing measures necessary to prevent cold stress hypothermia.

Danger of Plexiglass Oxygen Hood: Query and Clarification

In his recent paper,1 Dr. Indyk states that a dangerous situation in newborn thermoregulation arises with the use of plexiglass oxygen hoods in infants placed under radiant heat infant warmers. One might infer from the data that a decrease in a newborn's optimal core temperature is associated with the combined use of plexiglass hoods and infant warmers. There is an inherent problem, however, in applying purely physical data, as the author has done, to a biological system, i.e., the newborn infant.