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Mishra U, August D, Walker K, Jani PR, Tracy M. Thermoregulation, incubator humidity, and skincare practices in appropriate for gestational age ultra-low birth weight infants: need for more evidence. World J Pediatr 2024:10.1007/s12519-024-00818-x. [PMID: 38864998 DOI: 10.1007/s12519-024-00818-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/02/2023] [Accepted: 05/13/2024] [Indexed: 06/13/2024]
Abstract
BACKGROUND Although not universal, active care is being offered to infants weighing < 500 g at birth, referred to as ultra-low birth weight (ULBW) infants appropriate for gestational age. These infants have the greatest risk of dying or developing major morbidities. ULBW infants face challenges related to fluid and heat loss as well as skin injury in the initial days of life from extreme anatomical and physiological immaturity of the skin. Although there is an emerging literature on the outcomes of ULBW infants, there is a paucity of evidence to inform practice guidelines for delivering optimal care to this cohort of infants. DATA SOURCES A comprehensive review of the literature was performed using the PubMed and Embase databases. Searched keywords included "thermoregulation or body temperature regulation", "incubator humidity", "skin care", "infant, extremely low birth weight" and "ultra-low birth weight infants". RESULTS Evidences for thermoregulation, incubator humidity, and skincare practices are available for preterm infants weighing < 1500 g at birth but not specifically for ULBW infants. Studies on thermoregulation, incubator humidity, or skincare practices had a small sample size and did not include a sub-group analysis for ULBW infants. Current practice recommendations in ULBW infants are adopted from research in very and/or extremely low birth weight infants. CONCLUSIONS This narrative review focuses on challenges in thermoregulation, incubator humidity, and skincare practices in ULBW infants, highlights current research gaps and suggests potential developments for informing practices for improving health outcomes in ULBW infants. Video abstract (MP4 1,49,115 kb).
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Affiliation(s)
- Umesh Mishra
- Faculty of Medicine and Health, University of Sydney, Sydney, Australia
- Department of Neonatology, Westmead Hospital, Westmead, NSW, Australia
| | - Deanne August
- Grantley Stable Neonatal Unit, Royal Brisbane and Women's Hospital, Brisbane, Australia
- School of Nursing, Midwifery and Social Work, University of Queensland, Brisbane, Australia
| | - Karen Walker
- Faculty of Medicine and Health, University of Sydney, Sydney, Australia
- Department of Newborn Care, Royal Prince Alfred Hospital, Camperdown, Australia
| | - Pranav R Jani
- Faculty of Medicine and Health, University of Sydney, Sydney, Australia.
- Department of Neonatology, Westmead Hospital, Westmead, NSW, Australia.
| | - Mark Tracy
- Faculty of Medicine and Health, University of Sydney, Sydney, Australia
- Department of Neonatology, Westmead Hospital, Westmead, NSW, Australia
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Jani PR, Maheshwari R, Skelton H, Viola P, Thomas S, Ryder L, Culcer M, Mishra U, Shah S, Baird J, Elhindi J, Padernia AM, Goyen TA, D'Cruz D, Luig M, Shah D. Temperature probe placement in very preterm infants during delivery room stabilization: an open-label randomized trial. Pediatr Res 2024:10.1038/s41390-024-03115-5. [PMID: 38443526 DOI: 10.1038/s41390-024-03115-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/05/2023] [Revised: 02/01/2024] [Accepted: 02/17/2024] [Indexed: 03/07/2024]
Abstract
BACKGROUND Variation in practice exists for temperature probe positioning during stabilization of very preterm infants (<32 weeks gestation). We explored the influence of temperature probe sites on thermoregulation. METHODS An open-label, stratified, balanced, parallel, randomized trial was conducted. Inborn infants were randomly assigned temperature probe to the axilla or to the upper back. The primary outcome was normothermia (local range: 36.8-37.3 °C and World Health Organization (WHO) range: 36.5-37.5 °C) at admission to the neonatal intensive care unit. RESULTS Between 1 November 2018 and 4 July 2022, 178 infants were randomly assigned to one of the two sites (n = 89 each), 175 included in the final analysis. Normothermia (local range) was achieved for 39/87 infants (44.8%) assigned to the upper back compared to 28/88 infants (31.8%) assigned to the axilla [risk difference:13%; 95% CI -1.3-27.3]. Normothermia (WHO range) was achieved for 78/87 infants (89.7%) assigned to the upper back compared to 70/88 infants (79.6%) assigned to the axilla [risk difference:10.1%; 95% CI -0.5-20.7]. No infant recorded temperatures >38 °C or developed skin injury. CONCLUSIONS In very preterm infants, upper back site was equally effective as the axilla in maintaining normothermia, with no increase in adverse events. CLINICAL TRIAL REGISTRATION The study was registered with the Australian New Zealand Clinical Trials Registry (ACTRN12620000293965). IMPACT Substantial variation in practice exists for the site of securing a temperature probe during delivery room stabilization of very preterm infants and the influence of temperature probe site on thermoregulation remains unknown. In this study, upper back site was equally effective as the axilla in maintaining normothermia, with no increase in adverse events. Clinicians could adopt upper back site for maintaining normothermia. This study may contribute data to future international participant data prospective meta analysis of randomized controlled trials worldwide on temperature probe positioning in very preterm infants, increasing translation of research findings to optimize thermoregulation and clinical outcomes.
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Affiliation(s)
- Pranav R Jani
- Department of Neonatology, Westmead Hospital, Westmead, NSW, Australia.
- The Reproduction and Perinatal Centre, Faculty of Medicine and Health, The University of Sydney, Sydney, NSW, Australia.
| | - Rajesh Maheshwari
- Department of Neonatology, Westmead Hospital, Westmead, NSW, Australia
- The Reproduction and Perinatal Centre, Faculty of Medicine and Health, The University of Sydney, Sydney, NSW, Australia
| | - Hannah Skelton
- Department of Neonatology, Westmead Hospital, Westmead, NSW, Australia
- School of Nursing and Midwifery, Western Sydney University, Penrith, NSW, Australia
| | - Patricia Viola
- Department of Neonatology, Westmead Hospital, Westmead, NSW, Australia
| | - Sheela Thomas
- Department of Neonatology, Westmead Hospital, Westmead, NSW, Australia
| | - Lynette Ryder
- Department of Maternal and Fetal Medicine, Westmead Hospital, Westmead, NSW, Australia
| | - Mihaela Culcer
- Department of Neonatology, Westmead Hospital, Westmead, NSW, Australia
- The Reproduction and Perinatal Centre, Faculty of Medicine and Health, The University of Sydney, Sydney, NSW, Australia
| | - Umesh Mishra
- Department of Neonatology, Westmead Hospital, Westmead, NSW, Australia
- The Reproduction and Perinatal Centre, Faculty of Medicine and Health, The University of Sydney, Sydney, NSW, Australia
| | - Swapnil Shah
- Department of Neonatology, Westmead Hospital, Westmead, NSW, Australia
- The Reproduction and Perinatal Centre, Faculty of Medicine and Health, The University of Sydney, Sydney, NSW, Australia
| | - Jane Baird
- Department of Neonatology, Westmead Hospital, Westmead, NSW, Australia
| | - James Elhindi
- The Reproduction and Perinatal Centre, Faculty of Medicine and Health, The University of Sydney, Sydney, NSW, Australia
- Research and Education Network, Westmead Hospital, Westmead, NSW, Australia
| | | | - Traci-Anne Goyen
- Department of Neonatology, Westmead Hospital, Westmead, NSW, Australia
| | - Daphne D'Cruz
- Department of Neonatology, Westmead Hospital, Westmead, NSW, Australia
| | - Melissa Luig
- Department of Neonatology, Westmead Hospital, Westmead, NSW, Australia
| | - Dharmesh Shah
- Department of Neonatology, Westmead Hospital, Westmead, NSW, Australia
- The Reproduction and Perinatal Centre, Faculty of Medicine and Health, The University of Sydney, Sydney, NSW, Australia
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Ardern J, Hayward B, Vandal AC, Martin-Babin M, Coomarasamy C, McKinlay C. Improving Golden Hour Care Coordination: Using Defined Roles to Improve Nurse Confidence and Care Coordination of Neonates Following Admission. J Perinat Neonatal Nurs 2023; 37:232-241. [PMID: 37310073 PMCID: PMC10445624 DOI: 10.1097/jpn.0000000000000721] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/25/2022] [Accepted: 01/16/2023] [Indexed: 06/14/2023]
Abstract
STUDY AIM To investigate whether use of admission lanyards improves nurse confidence, care coordination, and infant health outcomes during neonatal emergency admissions. METHODS Admission lanyards that defined team roles, tasks, and responsibilities were evaluated in a mixed-methods, historically controlled, and nonrandomized intervention study. Methods included (i) 81 pre- and postintervention surveys to explore nurse confidence, (ii) 8 postintervention semistructured interviews to elicit nurse perceptions of care coordination and nurse confidence, and (iii) a quantitative comparison of infant care coordination and health outcomes for 71 infant admissions before and 72 during the intervention. RESULTS Nurse participants reported that using lanyards during neonatal admissions improved clarity of roles and responsibilities, communication, and task delegation, contributing to better admission flow, team leadership, accountability, and improved nurse confidence. Care coordination outcomes showed significantly improved time to stabilization for intervention infants. Radiographies for line placement were performed 14.4 minutes faster, and infants commenced intravenous nutrition 27.7 minutes faster from time of admission. Infant health outcomes remained similar between groups. CONCLUSION Admission lanyards were associated with improved nurse confidence and care coordination during neonatal emergency admissions, significantly reducing time to stabilization for infants, shifting outcomes closer to the Golden Hour.
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Affiliation(s)
- Julena Ardern
- Kidz First Neonatal Care, Te Whatu Ora Counties Manukau, Auckland, New Zealand (Ms Ardern and Dr McKinlay); Ko Awatea, Te Whatu Ora Counties Manukau, Auckland, New Zealand (Mss Hayward, Martin-Babin, and Coomarasamy and Dr Vandal); and Departments of Statistics (Dr Vandal) and Paediatrics: Child and Youth (Dr McKinlay), University of Auckland, Auckland, New Zealand
| | - Brooke Hayward
- Kidz First Neonatal Care, Te Whatu Ora Counties Manukau, Auckland, New Zealand (Ms Ardern and Dr McKinlay); Ko Awatea, Te Whatu Ora Counties Manukau, Auckland, New Zealand (Mss Hayward, Martin-Babin, and Coomarasamy and Dr Vandal); and Departments of Statistics (Dr Vandal) and Paediatrics: Child and Youth (Dr McKinlay), University of Auckland, Auckland, New Zealand
| | - Alain C. Vandal
- Kidz First Neonatal Care, Te Whatu Ora Counties Manukau, Auckland, New Zealand (Ms Ardern and Dr McKinlay); Ko Awatea, Te Whatu Ora Counties Manukau, Auckland, New Zealand (Mss Hayward, Martin-Babin, and Coomarasamy and Dr Vandal); and Departments of Statistics (Dr Vandal) and Paediatrics: Child and Youth (Dr McKinlay), University of Auckland, Auckland, New Zealand
| | - Margot Martin-Babin
- Kidz First Neonatal Care, Te Whatu Ora Counties Manukau, Auckland, New Zealand (Ms Ardern and Dr McKinlay); Ko Awatea, Te Whatu Ora Counties Manukau, Auckland, New Zealand (Mss Hayward, Martin-Babin, and Coomarasamy and Dr Vandal); and Departments of Statistics (Dr Vandal) and Paediatrics: Child and Youth (Dr McKinlay), University of Auckland, Auckland, New Zealand
| | - Christin Coomarasamy
- Kidz First Neonatal Care, Te Whatu Ora Counties Manukau, Auckland, New Zealand (Ms Ardern and Dr McKinlay); Ko Awatea, Te Whatu Ora Counties Manukau, Auckland, New Zealand (Mss Hayward, Martin-Babin, and Coomarasamy and Dr Vandal); and Departments of Statistics (Dr Vandal) and Paediatrics: Child and Youth (Dr McKinlay), University of Auckland, Auckland, New Zealand
| | - Chris McKinlay
- Kidz First Neonatal Care, Te Whatu Ora Counties Manukau, Auckland, New Zealand (Ms Ardern and Dr McKinlay); Ko Awatea, Te Whatu Ora Counties Manukau, Auckland, New Zealand (Mss Hayward, Martin-Babin, and Coomarasamy and Dr Vandal); and Departments of Statistics (Dr Vandal) and Paediatrics: Child and Youth (Dr McKinlay), University of Auckland, Auckland, New Zealand
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