Comparison of rectal, axillary, abdominal skin and tympanic membrane temperature measurements in term and preterm neonates.

A quasi-experimenal study was conducted to investigate the optimum time and accuracy of temperature measurements from four sites: rectum (2.5 cm and 3 cm beyond the anus in preterm and term neonates, respectively), axilla (with mercury-in-glass thermometers), abdominal skin (with Duotemp Temperature Monitor), and tympanic membrane (with FirstTemp Genius Infrared Tympanic Thermo-meter in the rectal-equivalent mode). A convenience sampling technique was utilized to enroll 109 neonates, 52 stable preterm and 57 healthy term neonates from a nursery of a university medical center. Simultaneous measurements were made at the four sites by three observers. Each infant was studied only once. The highest temperatures were recorded when temperature readings remained unchanged for two minutes. The findings demonstrated that the rectal temperature was significantly higher than the axillary (mean differences of 0.06 and 0.09oC in preterm and term neonates, respectively) and the abdominal skin temperatures (0.3oC in preterm and 0.2oC in term neonates). However, the differences between rectal and axillary temperatures were considered no clinical significance. Tympanic temperatures were significantly higher than the rectal. The mean differences between tympanic and rectal temperatures varied widely depending on the ear side (0.88 and 0.52oC for protected ears, 0.63 and 0.21oC for exposed ears in preterm and term infants, respectively). The temperatures of preterm neonates were not significantly different from the term neonates measured at rectum, axilla, and abdominal skin. Preterm neonates required shorter times to achieve highest temperatures at all sites. There were significant differences in the mean times of axillary and abdominal skin measurements between preterm and term neonates. The mean times of placement in preterm and term neonates, 2.8 and 3.4 minutes for rectum, 5.4 and 7.9 minutes for axilla, and 4.0 and 6.1 minutes for abdominal skin, were considered the optimum times since 91 to 100 per cent of neonates had temperature readings within their highest temperatures - 0.1oC. Conclusion: The axillary temperature is as accurate as rectal temperature measured with mercury- in-glass thermometer if the placement times are optimum. The rectal temperature equals the abdominal skin plus 0.3oC for preterm and plus 0.2oC for term neonates. Temperatures obtained with infrared tympanic thermometer in the rectal equivalent mode do not accurately reflect and is not recommended to substitute for rectal temperatures in neonates.

Measurements of the irradiance and the effect on environmental temperature of the Siriraj phototherapy lamp.

The Siriraj Phototherapy Lamp (SPL) was invented by the investigator to compensate for a similar, but expensive imported device and h low-efficiency locally-made device. The SPL irradiance and effect on environmental temperature were measured in this study. The device used six fluorescent bulbs of which zero to three were blue. The distance between the bulbs and the mattress was fully adjustable. The blue fluorescent bulb emitted a higher light intensity than the white. In both kinds of bulbs the intensity of light was higher in the center of the bulbs than at the periphery. The light intensity varied proportionately with the number of blue fluorescent bulbs, but inversely with the distance between the bulbs and the mattress. Lining the SPL with a white cloth increased the light intensity. This inverse relationship was also found between the environmental temperature near the mattress and the distance. Placing a plastic shield under the SPL reduced the radiant heat emitted by the bulbs to the mattress which resulted in a decrease of environmental temperatures by 2.3oC and 3.0oC at the distances of 45 and 30 cm, respectively.

The effect of measures minimizing body heat loss on the prevention of neonatal hypothermia in the delivery room.

The prospective study was undertaken to observe the pattern of fall in the rectal temperature that occurred in neonates after birth and to determine the birth rectal temperature, the relationship of birth temperature between mothers and babies and the effect of measures minimizing body heat loss on the prevention of neonatal hypothermis in the delivery room. The measure given were placing a radiant warmer close to the mother’s lower extremities to provide a higher thermal environment for the neonate before the anticipated time of delivery, drying the neonate immediately after birth with a prewarmed dry towel, placing it under a preheated overhead rediant warmer from the time it was moved to the bathing area to the time being transferred to the nursery. Rectal temperatures were taken immediately after birth, immediately transferred to the bathing area, after cleaned and on admission to the nursery. Three groups, each of 37 infants, of term infants with normal deliveries and with Apgar scores of > 8 were studied. Infants in group 1 receiving routine care provided in the delivery room were observed for the fall in the rectal temperature. Those in group 2 and 3 were studied to evaluate the effect of measures minimizing body heat loss on the prevention of hypothermia: group 2 received only routine care; group 3 received both routine care and the measures minimizing heat loss. The mean birth rectal temperature was 37.6+0.5 oC (range 36.7 – 39.1). The correlation coefficient of the relationship between the birth and temperatures of mothers and babies was 0.61 (p = 0.01). Under routin care newborns lost heat rapidly at birth and during the period they were in the delivery room. Washing soon 5 – 20 minutes after birth caused a rapid fall in body temperature. By 18.7 mins after birth the mean rectal temperature was 36.4 oC and at a mean age of 68.5 mins 95% of the neonates had hypothermia. Swaddling neonates with towel could not prevent body heat loss. The fall in body temperature that occurred in group 3 was significantly less when compared to group 2 and non in group 3 suffered from hypothermia. This study demonstrates that efforts to limit heat loss should be concentrated immediately after birth and on the practice of cleaning neonates in the delivery room. Measures minimizing heat loss can effectively prevent hypothermia in the dilvery room.

Factors influencing nurses’ behavior in promoting patient self-care.

Despite the effectiveness of self-care promotion strategy on patients’ health outcome, little is known about strategy adopted by nurses and factors influencing nursing practice behavior. The purpose of this study was to determine the contribution of sociodemographic variables, attitude toward patient self-care, and knowledge on self-care promotion strategy to nurses’ behavior in promoting patient self-care. A cluster random sampling was used to recruit samples from four major hospitals in metropolitan area. Data were collected by using self-report questionnaire with responses from 351 nurses. The finding demonstrated that the appropriateness of nurses’ behavior in promoting patient self-care was fair. Stepwise multiple regression analysis showed that nurses’ perception of hospital policy and nursing departments were the predictor of nurse’ behavior in promoting patient self-care. Only 53.8% of nurses had congruent with the actual hospital policy. Learning experience in self-care promotion also significantly correlated with perception of hospital policy. Nurses who learned self-care promotion from undergraduate school or postgraduate short course training program did not have significantly different attitude and knowledge about self-care from those who did not have such learning experience. The effect of self-care education on nurse behavior was seen only in the group that received short-course training. The results suggest that hospital policy needs to be reevaluated foe its clarification and operating function and method of teaching self-care promotion for nurses must be emphasized on experiential learning model rather than traditional model.

The effect of posture on oxygen saturation and respiratory status in postextubated preterm infants.

A crossover, quasi-experimental design was conducted to evaluate the optimal posture among four positions (supine, prone, left lateral, and right lateral) in preterm infants within 48 hours postextubation. Oxygen saturation, respiratory rate, and Silverman-Anderson retraction score were utilized to evaluate the optimal posture. Fifteen preterm infants, thirteen male and two female, with a mean birthweight of 1,251 g (range 610-1,800 g), a mean postnatal age of 18.87 days (range 2-39 days), and a mean postextubation period of 23.5 hours (range 6-38 hours) were studied. Seven infants suffered respiratory failure from respiratory distress syndrome, three from pneumonia, two from perinatal asphyxia, and one from each of the following disorders: patent ductus arteriosus, pneumothorax, and apnea. Each infant was randomly assigned to each position. Oxygen saturation, respiratory rate, and Silverman-Anderson retraction score were recorded when the seconds. Significant differences in mean oxygen saturation and Silverman-Anderson retraction score were not detected for any positions (p = 0.377 and p = 0.51, respectively) but postures did influence respiratory rate (p = 0.001). The mean respiratory rate was 58.9 breaths per minute (bpm) in left lateral position, and 59.9 bpm in right lateral position both being significantly higher than the mean respiratory rate of 54.2 npm in supine position (p = 0.003 and 0.007, respectively). In prone position, the mean respiratory rate was 57.2 bpm which was not significantly different from the mean respiratory rate in supine position (p = 0.059). We conclude that the appropriate posture for preterm infants during the 48-hour postextubation period is all four postures positioned alternately. It there is any deterioration in oxygen saturation in any particular posture, that specific posture should be avoided.