TEMPERATURE UPDATED: 5/29/2010 ______2007 Review of Moore et al., 2007 in which infants who got VEKC stayed warmer than infants who did not get BIRTH KC. Under references to KC. KC keeps infant warm & is recommended. WARMING ______, 1995. Safe Mother _____, 1999 Childbirth Ed Acolet et al., 1989 Altimier 2001 Anderson et al., 2002 Anderson et al., 2003 Argote et al., 1991 Bauer,S, F, L, 1996 Bauer, Pasel, Versmold, 1996 Bauer, Pyper et al., 1998 Bauer, Uhrig et al., 1997 Begum et al., 2009 Bergstrom et al., 2005 Bergstrom et al., 2007 Bier et al., 1996 ArchPedAdols Bohnhorst et al., 2001 Bohnhorst et al., 2004 Bonner 2007 Bonner 2008 Bosque et al., 1995 Byaruhanga et al. 2005 Bystrova et al., 2007 Bystrova et al., 2003 PT, review, includes temperature effects Cochrane prep. Review of articles shows that KC babies maintain temp better than others. KMC Cochrane results. KC babies maintain temp better. PT, descriptive of 6 infants who got KC starting 10-20 minutes post-birth X 6 hours and were warmer in KC than in incubator. BIRTH KC PT, temps rose in KC PT,May not be Kc STUDY PT, 27 wks lost body (rectal) heat, 28 wks gained heat. Maternal chest temp was 34.3-34.4 (same as surface of mattress in incubator) PT. Rectal, Foot, Foot and rectal temps increased during KC PT, pretest-test-posttest one group. Body temp of 36 wk postconceptional age infants increased sig during KC(37.0 preKC to 37.3KC [no posttest values available]). FT, RCT, Uganda babies warmed up faster after bath in KC than in warmer units. REWARMING FT, mat breast temp increased immediately when baby placed in KC. BREAST TEMP CHANGES PT. Axillary PT,Rectal, increased during 2 hrs of KC 36.9→37.3 PT, Rectal, pretest mean=36.9, 2hrs of kc=36.9, posttest=37.5 (in extra heated incubator for posttest). No rise in temp during two hours of KC. PT, VLBW, case study of one mech vent infant given KC and then swaddled holding. MECHANICAL VENT/SWADDLED PT, two female fraternal twins, one in KC for 2 hr 4 times in two weeks, the other in swaddled holding. No stat difference in axillary temp, but KC temp was clinically higher. (98 vs 99.5). SWADDLED PT, Skin temp decreased FT, re-warming after birth bath is faster in KC than in warming units REWARMING FT, RCT, compared infants swaddled and prone on mom’s chest to KC and prone on moms chest to those in nursery. Mat breast temp was related to infant foot and axillary temp. Took Axillary and Breast temp of mom and infant Axillary and Foot temps. Foot temps rose higher than axillary temps. SWADDLED, BREAST TEMP FT, Axillary, Thigh, Back, Foot, all temps rose in 30-120 mins KC postbirth with fullterms. Foot temps rose higher and stayed higher in KC than other two groups.BIRTH KC Bystrova , M, V et al., 2007 Bystrova, M,W et al., 2007 Carfoot et al., 2005 Charpak et al., 2005 Chiu et al., 2005 Chen, Wang et al.,2000 Chiou & Blume-Peytavi, 2004 Christensson, 1996 Christensson et al., 1998 Christensson et al., 1995 Christensson, Siles 1992 Christidis et al., 2003 Chwo et al., 2002 Clarke, 2009 Clifford & Barnsteiner, 2001 Conde-Agudelo et al., 2003 Constantinou et al., 1999 Curry, 1979 Curry, 1982 De Leeuw et al., 1991 DiMenna,2006 Dodd 2005 Dombrowski et al., 2000 Durand, et al., 1997 Dzukou et al. 2004 Engler, 2005 Fardig, 1980 Filho (Lamy Filho)et al., 2008 FT, RCT Maternal breast and axillary temps rise after onset of KC and rise more in multiparas than primiparas. BIRTH KC, BREAST TEMP FT, RCT, Infants warmer in KC than in cot. FT, RCT. Infant temp 1hour postbirth higher in KC than control group infants. BIRTH KC Review. Relates temperature stability during KC FT. Descriptive.Temporal artery temps reached and maintained thermoneutral range during BF in KC. BFKC ??,Body temp increased in KCBF but not in KC during bottle feeding BFKC PT, Kangaroo Care is being developed as a strategy to minimize Transepidermal water loss (pg. 63-64). FT, Axillary, 24 hrs postbirth, temp increase.in KC FT and PT (some 33 wks ga), RCT, 80 hypothermic babies (temps as low as 34C). Axillary, by 24hrs postbirth 90% kc VS 60% cot had warmed adequately. REWARMING Were 36.5. REWARMING article and RCT FT, Axillary, 90 minutes postbirth KC=36.9, cot=36.4. Temp of KC babies is higher than temp of cot babies.Thermoregulation by KC persists for 2-3 days and is mediated by increased cutaneous circulation due to sympatholytic activity FT,Axillary,90 mins postbirth KC=37.1,cot=36.8. Temp of KC babies is higher than temp of cot babies. FT, Infrared thermography shows KC prevents heat loss PT, RCT Tympanic, higher temp in KCBF than swaddled BF, KCBF, SWADDLED Rev of KC in developing countries and says KC has thermoregulation benefit and so it should be used everywhere PT,Clin report Temp stability maintained PT, Cochrane. Less hypothermia and hyperthermia in KC than Incubator care infants PT, Axillary,no change pretest-test-posttest in KC FT, Temps taken q 15 min during 15-60 mins of KC at Birth, all temps stable. BIRTH KC FT, BIRTH KC PT, VLBW, unstable respiratory status had 60 mins of Pat/Mat KC and rectal temp was 36.8 before and 37.0 after, not significantly different. BIRTH KC PT, review that says KC improves thermal regulation PT, REVIEW, says temperature studies show infants stay warm during KC FT, temp rose to 36.5-37.8 after two hours of BF in KC, but not in infants bottle fed under radiant warmer. KCBF PT, in developing countries KMC regulates temp PT, took Fingertip temp of mom as sign of stress. Fingertip temp rose when doctor approached. FT, Axillary/Abd? Rectal, temps taken q 3 min over 45 Mins of KC. Rectal at 21,45 mins.More controls Had skin and rectal temps below NTZ at both times -this is 3 group study: kc after initial care, KC immediately, and no KC groups. PT, clin eval of 8 KMC step down units vs 8 without KMC. No difference in # of hypothermia/hyperthermia episodes between the units. Fohe et al., 2000 Fransson et al., 2005 Galligan, 2006 Gomez-Papi, et al.,1998 Gouchon et al., 2010 Harris, 2007 Harris 1994 Huang et al., 2006 Ibe et al., 2004 Johanson et al., 1992 Jonas et al., 2007 Kambarami et al., 2002 Karlsson 1996 Kennedy, et al., 2000 Ludington-Hoe et al., 2006 Ludington-Hoe et al., 2000 Ludington-Hoe et al., 1994 Ludington-Hoe et al., 1991 PT, Quasi-exp. Rectal Temp increased 0.3C during 90 min KC FT, one group descriptive. Rectal, abdominal, and foot temps were higher when infant was with mom than when in cot. Infants were wearing diaper, cotton vest, and romper when with mom; in cot dressed the same + blanket over him. No heat loss when with mom. 48 hours of recording starting 48 hours postbirth. POSTPARTUM DAY 1 FT, Evidence-based guideline for REWARMING fullterm infants during first 72 hours postbirth. BIRTH KC FT, KC in DR, temp related to duration of KC 96% had axillary temp >36 BIRTH KC FT, RCT of KC or routine care starting 41-61 minutes after elective C/S. Infant temps did not differ between groups. No risk of hypothermia in c/s group. BIRTH KC CESAREAN PT, case study of hypothermic infant in war zone. KC increased the infant’s temp, article recommends KC for prevention of hypothermia in war zones FT, clin report of using water bath to get infants to breast. “Continual pouring of water over the baby keeps him adequately warmed” p. 468. PT, RCT, very early KC after c/S during post-op recovery. Kc infants warmer than those under radiant warmer 4 hours later. Hypothermia tx. PT, Axillary (core) vs forehead (peripheral) temp. Hypothermia reduced by 90% and more hyperthermia>37.5, and core-periphery temp Widened in KC compared to incubator. Risk of hyperthermia >37.9 not significant. MICRO-AMBIENT temp higher in KMC than incubator tho room temp was same. PT/FT. KC used immediately after birth (BIRTH KC) to keep babies warm and was as useful as swaddling and oil massage. ReWARMING FT, Quasi Exp, examined skin temp during KC (PPD2) and it was higher when first placed in KC in epidural analgesia group than controls (no epidural), but then KC group + epidural analgesia did not rise as it did in KC without epidural. Epidural and oxytocin impair skin temp rises during KC at 2 days postpartum. FT, retrospective survey. FT, 9 infants with mean temp of 36.3 attained and maintained rectal temps of 37.0 or more within 60 minutes of KC onset At an average of 37min post KC start time during a 60 min session of KC. PT, used KC for REWARMING in Africa PT twins, Case study. Shared KC breast and infant temps move in synchrony based on infant temp needs. Abd. Temps in babies, Breast skin temp in moms. PT, RCT. Toe Temps higher in KC than controls. Maternal Breast temps taken and moved quickly into neutral thermal zone. Synchrony is possible. PT, review of studies that show KC prevents hypothermia in PT infants. PT, KC warms infants, preventing hypothermia as measured by Abdominal temps. Mallet et al., 2007 Mance, 2008 Marin et al., 2010 Maastrup & Greisen, 2010 Mattson & Smith, 2004 (text) McCall et al., 2005,2007 Mooncey et al., 1997 Moore et al., 2007 Mori et al., 2009 Neu, Brown, Vojir 2001 Parmar et al., 2009 Romano 2007 Smith, 2001 Swinth et a l., 2002 Sontheimer et al., 2004 Van Sleuwen et al., 2007 VanZanten 2007 Vaughans, 1990 Wahlberg et al, 1992 Wallis 2000 Yin et al., 2000 (Chinese) PT, descriptive study of NICU staff knowledge about KC and most were concerned about hypothermia and it was one cited reason as a barrier to KC’s use. PT, FT, Review of keeping infant warm in delivery room. In table 3 says KC can be done once mother and infant are dried and head cap is on baby. FT, RCT, birth KC increased infants temp by 0.07 degrees BIRTH KC PT, ELBW 26 +6wks pma, skin temp increasedby 0.1C with 98 mins maternal KC, lost 0.3C with paternal KC and no difference in skin temp between120 mins incubator before and after KC FT. recommends on page 423 KC for thermal support during the adaptation to extrauterine life period. BIRTHKC PT/LBW.Cochrane meta-analysis. KC prevents hypothermia in PT and LBW infants better than incubator care when given in 1st 10 minutes postbirth. PREVENTS HYPOTHERMIA PT, descriptive. Temp was 36.5-37.0 during 20 mins of KC FT, Cochrane Meta-analysis, Infants who got VEKC stayed warmer than those who did not. BIRTH KC PT, FT, meta-analysis. Temp rises. PT, RCT, Axillary T was stable before and after KC. Temp remained stable through transfers into, out of ventilated KC PT, clinical observations. No hypothermia during 4 hour sessions of KC in India. Temp increased from 36.75 to 37.23 during each session. Decreased use of heating devices FT, review of Jonas 2007 and good commentary on how interventions prevent natural response to KC. PT, BPD babies. During KC higher skin (37.02) and leg temps occurred than during incubator (36.58 for skin temp). PT case study of temp during vent KC Rectal T was stable during transport and was 36.537.4 after KC transport. Regulated temp by adding/ removing blankets during transport. Swaddling is not as good as kc for prevention of hypothermia. PT, micropreemie, pretest-test-posttest. Skin temp dropped in infants<28 weeks during KC FT. Temps during KC compared to those under radiant warmer. PT, infant temp maintained. Mothers act as incubators. PT,Quasi-Exp.one group pretest-test-posttest. No diff in temp over 30 mins of KC vs. in incubator over 7 days of testing.. MECHANISMS.Mechanism of Heat Loss in ELBW infants is lack of vasomotor maturity because infants cannot peripherally constrict their blood vessels (have peripheral vasoconstriction) in face of cold environment in first 12 hours of life (Knobel RB, Holditch-Davis DD, Schwartz TA, Wimmer JE Jr. 2009. ELBW preterm infants lack vasomotor response in relationship to cold temperature at birth. J Perinatology 29(12), 814-821. And earlier they found the same thing, that they were cold, and recommended putting baby is a plastic bag up to the next (Knobel R, Holditch-Davis DD. 2007. Thermoregualtion and heat loss prevention after birth and during NICU stabilization of ELBW infants. JOGNN 36(3), 280-287. IDEAL Temp: For ELBW infants (<29 wks GA, BW of 400-1000g) the best temp is 36.8 (Knobel RB, Holditch-Davis D, & Schwartz TA. (2010). Optimal body temperature in transitional extremely low birth weight infants using heart rate and temperature as indicators. JOGNN 39(1), 3-14) Maternal-Neonatal Thermal Synchrony Bergstrom et al., 2007 Bystrova et al., 2007 Chiu et al., 2005 Christensson et al., 1998 Hendricks-Munoz, 2002 Ibe et al., 2004 Karlsson 1996 Kennell 2006 Ludington 1990 Ludington-Hoe et al., 1994 Ludington-Hoe et al., 2000 Ludington-Hoe et al, 2006 Richardson, 1997 FT. says on page 119 that when infant was cool, temps rose to neutral thermal zone; when infant was too warm, temps dropped. This suggests that mothers have ability to modulate infant temperature if given the opportunity. PT, FT, infants gain body heat from mother when temp is <36.3 but lose heat to mother when temp is >37C, eliminating risk of heat stress. PT, clinical report. “From almost the moment the infant is in the ‘kangaroo’ position, the mother’s body will respond accordingly, either cooling down or warming up in response to the baby’s need at any given time” PT, measure microambient temp(next to infant under bra top when in KC position (pg. 247). FT, heat flux occurs from mother to infant, allowing infant to conserve heat and warm up. FT, comments on the remarkable skills of breasts to adjust to infant temperatures in Ludington-Hoe 2006 PT,RCT, measured breast and infant temps and showed temperature synchrony. Case study PT twins. Breasts behave independently of each other to keep each infant warm and to raise and lower infant temperature as infant’s needs mandate. SYNCHRONY “Mother’s naturally modulate the warmth of their breasts to keep their infants at the optimal temp…” OTHER TEMPERATURE STUDIES D’Souza S.W., Tenreiro, S., Minors D., Chiswick M.L. Sims D.G. & Waterhouse, J. (1992 or 1993. Skin temperature and heart rate rhythms in infants of extreme prematurity. ??? This article is really about the temporal patterns of the NICU. 9 preterms of 26-29 weeks GAspent 6-17 weeks inNICU (1300 lux). Hourly recording of temp and HR occurred. After recovery (first 15 weeks of life), moved to 12 hour day/night light cycled nursery. 4/9 infants developed circadian rhythms in temp and 3 in HR in light /dark periods. HR increased Move preemies to light/dark rooms earlier to foster synchronization of body clock with 24 hour circadian rhythms of life.