TEMPERATURE
UPDATED: 5/29/2010 & 4/12/2014
Add Chitty 2013 when I get it. Preterm temps from delivery to NICU admission.
NO CHANGE IN TEMP, NO DIFFERENCE, STABILITY
Bohnhorst et al., 2004
Charpak et al., 2005
Clifford & Barnsteiner, 2001
Constantinou et al., 1999
Curry, 1979
De Leeuw et al., 1991
De Oliveira Azevedo et al. 2011
Heimann Jergus et al., 2013
Heimann Ebert et al. 2013
Heimann et al. 2010
INCREASE IN TEMP
______2007
_____, 1999 Childbirth Ed
Anderson et al., 2002
Anderson et al., 2003
Argote et al., 1991
Bauer,S, F, L, 1996
Bauer, Uhrig et al., 1997
Begum et al., 2009
Bergstrom et al., 2005
Bohnhorst et al., 2001
Boju et al. 2011
Bonner 2008
Byaruhanga et al. 2005
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.
Review. Relates temperature stability during KC
PT,Clin report Temp stability maintained
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
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, quasi=exp (1 grp pre-KC-post) showed stat sig differences
in HR, axillary temp, SaO2 and BP during 60 mins of KC in
ventilated infants, but no clinically significant differences so
they concluded that VS were STABLE and KC is SAFE in
intubated infants.
PT, descriptive, abdomen and back temps were maintained
during 90 minutes of KC.
Thermography studies
Review of Moore et al., 2007 in which infants who got
VEKC stayed warmer than infants who did not get BIRTH
KC.
WARMING occurs
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. 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
PT,Rectal, increased during 2 hrs of KC 36.9→37.3
PT,descriptive (Quasi-Exp?) of how 1 hr of KC increased
axillary temp by 0.4 degrees F in all subjects, by 0.6 degrees
F in SGA subjects, and by 0.3%in female subjects.
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
FT, re-warming after birth bath is faster in KC than in
warming units REWARMING
Bystrova et al., 2007
Bystrova et al., 2003
Bystrova, M,W et al., 2007
Carfoot et al., 2005
Chiu et al., 2005
Chen, Wang et al.,2000
Christensson, 1996
Christensson et al., 1998
Christensson et al., 1995
Christensson, Siles 1992
Christidis et al., 2003
Chwo et al., 2002
Heimann et al., 2013
Nimbalkar et al. 2014
Nolan & Lawrence, 2009
Park et al., 2013
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
FT, RCT, Infants warmer in KC than in cot.
FT, RCT. Infant temp 1hour postbirth higher in KC than
control group infants. BIRTH 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
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
PT, 0.62°C temp was lost in incubator before KC, from
beginning to 90 minutes of KC abdomen and back temps were
maintained and head and leg increased sig. and then all temps
dropped and were sig. less than KC temps in incubator
posttest.
PT,late Preterm, RCT of 50 having KC starting 3
0min-1 hour postbirth for first 24 hours postbirth (
got 16.98 hours of KC in first 24 hours of life and
spent second 24 hours of life in conventional care) vs
conventional care of NO kc for first 24 hours. All
infants had HR within normal limits. KC infants
warmer and only 4% had hypothermia vs. 32% of
controls. Newborns in the SSC group achieved rapid thermal
control as compared with the control group. Early SSC for
24 h after birth decreases incidence of hypothermia for initial
48 h of life.
FT, RCT of 25 cesarean infants who start KC >30 minutes
postbirth in PACU vs controls who were not in PACU.
Temperature was better in KC group than controls.
PT, 31 infants (micropreemies 25-28 wks GA) and older (2932 wk GA tested at 33-36 weeks with 1 hour in incubator and
one hour in kC. All infants had higher temp WNL during KC
and smaller GA infants had less variation in body temp and
faster thermoregulatory maturation than older GA infants.
PT, retrospective chart review showed infant temps higher
before and after KC were higher in KMC group than
conventional care group
PT, FT. The Warm Chain. KC is 3rd step in warm chain
Skin-to-skin contact is an effective method of
preventing heat loss in newborn, whether they be
full term or preterm. The mother’s chest or
abdomen is the ideal surface to receive the
newborn. It can be kept in skin to skin contact with
the mother while she is being attended to, during
transfer to the postnatal ward, and for the first hours
after birth.” (pg. 9).
Tuoni et al., 2012
World Health Org, 1997
DECREASE IN TEMP
Bauer, Pyper et al., 1998
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, Skin temp decreased
PT, VLBW, CPAP And Vent KC descriptive study of 141
episodes of 1st or 1st & 2nd sessions of KC. Infants had
transient and moderate decrease in mean axillary
temperature following the transfer from bed to mother (P <
.05). No other temp data provided.
Bosque et al., 1995
Carbasse et al. 2013
NO OR LESS HYPOTHERMIA
Conde-Agudelo et al., 2003
Conde-Agudelo et al. 2012
PT, Cochrane. Less hypothermia and hyperthermia
in KC than Incubator care infants
PT Cochrane of intermittent and continuous KMC. No
differences in hypothermia between groups.
spent second 24 hours of life in conventional care) vs
conventional care of NO kc for first 24 hours. All
infants had HR within normal limits. KC. infants
warmer and only 4% had hypothermia vs. 32% of
controls. Newborns in the SSC group achieved rapid thermal control
Stevens et al.2014
as compared with the control group. Early SSC for 24 h after birth
decreases incidence of hypothermia for initial 48 h of life.
FT. review of KC for C/S and says studies show that infant
stays warm in KC after c/s.
RECOMMENDATIONS KC TO MAINTAIN OR IMPROVE TEMP
______, 1995. Safe Mother
Clarke, 2009
Nimbalkar et al. 2014
Under references to KC. KC keeps infant warm & is
recommended.
Rev of KC in developing countries and says KC has
thermoregulation benefit and so it should be used everywhere
PT,late Preterm, RCT of 50 having KC starting 3
0min-1 hour postbirth for first 24 hours postbirth (
got 16.98 hours of KC in first 24 hours of life and
spent second 24 hours of life in conventional care) vs
conventional care of NO kc for first 24 hours. All
infants had HR within normal limits. KC infants
warmer and only 4% had hypothermia vs. 32% of
controls. Newborns in the SSC group achieved rapid thermal
Turnbull & Petty, 2013
World Health Org. 1997
KC for REWARMING.
Preer et al.,2013
control as compared with the control group. Early SSC for
24 h after birth decreases incidence of hypothermia for initial
48 h of life
PT, Rev of family centered care that promotes thermoregulation
of LBW infants and KC is one of the recommendations
The Warm Chain, KC is 3rd step in the warm chain to
prevent hypothermia
FT. descriptive,gave KC after bath at13 hrs age to
rewarm infants – it did and improved breast feeding
intiation and Exclusivity.
KC THERMOREGULATES BABY TEMP (Maternal –Neonatal Thermal
Synchrony)
Bergstrom et al., 200
DiMenna,2006
Conde-Agudelo et al. 2003
Institute of Medicine 2007
Ludington-Hoe et al., 2000 and others
Ludington-Hoe et al., 2007
Mori et al., 2010
US Breastfeeding Committee, 2013
World Health Organization, 1997
FT. study that shows maternal breast temperatures change
when infant is put to breast.
PT, review that says KC improves thermal regulation
PT, Cochrane Meta-analysis shows that KC is low cost way to
assist infant with temperature regulation
PT, Review in chapter 10 says Conde-Agudelo meta-analysis
said that KC is low cost way to assist preterm infants with
temperature regulation.
PT, RCT comparing maternal breast temperature changes to
incubator changes when infant is in KC and maternal breast
temperatures change immediately and go up and done,
regulating infant temperature
PT. Shared KC article shows that each breast regulates the
temperature of the infant on that breast separately.
PT, meta-analysis that confirms maternal thermoregulation of
infant temperature.
FT, reiterates that KC thermoregulates the infant and provides
warmth to prevent hyptothermia.
FT, PT, This is about keeping newborns warm and its says that
maternal breasts provide warmth and thermoregulate the
newborn’s temperature.
TRANSEPIDERMALWATER LOSS, SKIN HYDRATION, HUMIDITY
Chiou & Blume-Peytavi, 2004
PT, Kangaroo Care is being developed as a strategy to
minimize Transepidermal water loss (pg. 63-64).
MATERNAL TEMPERATURE
Bergstrom et al., 2007
FT, mat breast temp increased immediately when baby placed
in KC. BREAST TEMP CHANGES
Bystrova , M, V et al., 2007
Dicensza,2011
FT, RCT Maternal breast and axillary temps rise after onset of
KC and rise more in multiparas than primiparas. BIRTH KC,
BREAST TEMP
PT, mom’s report and she says that KC can keep baby warm
too and encourages nurses to let mom’s try KC
MISC
Acolet et al., 1989
Altimier 2001
Bauer, Pasel, Versmold, 1996
Bier et al., 1996 ArchPedAdols
Bonner 2007
Curry, 1982
Dodd 2005
Dombrowski et al., 2000
Durand, et al., 1997
Dzukou et al. 2004
Engler, 2005
Fardig, 1980
Filho (Lamy Filho)et al., 2008
Fohe et al., 2000
Fransson et al., 2005
Galligan, 2006
Gomez-Papi, et al.,1998
Gouchon et al., 2010
Hardy, 2011
PT, review, includes temperature effects
PT,May not be Kc STUDY
PT. Axillary
PT, VLBW, case study of one mech vent infant given KC and
then swaddled holding. MECHANICAL VENT/SWADDLED
FT, BIRTH KC
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.
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, reviews l-h’s Dev. Care chapter & relates that there is no
loss of temperature during KC
Harris, 2007
Harris 1994
Heimann et al. 2010
Huang et al., 2006
Ibe et al., 2004
Johanson et al., 1992
Jonas et al., 2007
Kambarami et al., 2002
Karlsson 1996
Karlsson et al., 2012
Kennedy, et al., 2000
Loring et al 2012
Ludington-Hoe et al., 2006
Ludington-Hoe et al., 2000
Ludington-Hoe et al., 1994
Ludington-Hoe et al., 1991
Mallet et al., 2007
Mance, 2008
Marin et al., 2010
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, VLBW, Micropreemie, descriptive comparison of 120
mins in KC vs 120 mins each in supine/prone incubator.Temp
was not different than in prone incubator.
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, NOT KC STUDYPER SE, but one that showed late
preterms lost less body heat with tub bath than sponge bath but
says that KC is accepted source of provision of external heat
and future studies should be done with KC.
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.
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, quasi-exp, birth KC increased infants temp by 0.07
degrees , but Birth KC infants were colder at one minute post-
Maastrup & Greisen, 2010
Mattson & Smith, 2004 (text)
McCall et al., 2005,2007
Mooncey et al., 1997
Moore et al., 2007
Mori et al., 2010
Munson et al. 2012
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)
birth, then warmer than non BKC infants at 5 mins postbirth.
More BKC infants had recovered from hypothermia than
controls by 5 mins. Hypothermia defined as axillary digital
temp <36C and temps were taken at 1 min, 5, minutes and 60
minutes post birth. End of hypothermia defined as axillary temp
≥ 36C. 30 KCers (21.8%) and 11 control infants (8%) had
hypothermia at one minute and 80% of KCers had recovered
from hypothermia by 5 minutes and 54.5% of controls had
recovered by 5 minutes but not statisciatlly sig difference.
BIRTH KC HYPOTHERMIA was concern.
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, Late preterm care guidelines and on page 268 it
recommends KC immediately after birth and continuing as
much as possible to avoid thermal stress.And says that KC can
be used during infant tests.
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..
SHOULD HAVE NO CLOTHING AT ALLin interface because it stops oxytocin
and temperature control in mom’s breasts:: Lindgren 2011
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.
MECHANISM FOR WEIGHT CHANGE. Newborn’s energy expenditure is first for
basic metabolism, then for thermoregulation, and last for body growth (Tourneux, P.,
Libert,J.P., Ghyselen, L., Leke, A., Delanaud, S., Degrugilliers,L., Bach, V. (2009). Heat exchanges and
thermoregulation in the neonate. Archives de Pediatrie, 16(7), 1057-1062.) When in KC, energy is
mostly directed to body growth rather than the first two (Samra et al., 2013, p. 198).
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
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.
Kennell 2006
Ludington 1990
Ludington-Hoe et al., 1994
Ludington-Hoe et al., 2000
Ludington-Hoe et al, 2006
Richardson, 1997
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.