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Lisa Fikac, RNC-NIC, MSN
Neonatal Outreach Coordinator Cape Fear Valley Health System PO Box 2000
Fayetteville, NC 28302

Office: (910)615-6933
Fax: (910)615-5472

 

Methods for Rewarming

RADIANT WARMERS

There are two modes used with the radiant warmer -

The manual mode is a constant source of heat that allows the radiant warmer to continue to heat even if the infant has the temperature probe attached.

This mode is used to pre-warm an admission bed or during a procedure, but caution should be used by monitoring the infant's temperature if the procedure is prolonged.

Remember in the manual mode the radiant warmer continues to heat no matter how hot or cold the infant may be.  

Never leave an infant unattended when the radiant warmer is in the manual mode.

The servo mode is used when an infant is lying under a radiant warmer. 

When the skin temperature is close to 36.5oC (97.8oF)  (slightly higher in the very low birth weight infant and slightly lower in the very large infant), the infant's core temperature will be close to 37oC (98.6oF).

Nursing care includes -

Keeping clothes off the infant--use only a small diaper

Taping the temperature probe to the infant's abdomen if lying in a supine position

Taping the temperature probe to the infant's lower back if lying in a prone position

Placing the probe close to the spleen or liver since they are highly vascular areas

Avoiding placement of the probe on extremities and bony surfaces.  This gives a false temperature reading which may lead to overheating the infant.

Cover the temperature probe tip with a reflective disc or cover.

To prevent false reading make sure the probe is not between the baby and the mattress.

The radiant warmer will alarm.  ALWAYS check the infant when a radiant warmer alarm sounds.  Make sure the probe is attached properly and the warmer is set on servo mode.

It is very important to monitor the infant's temperature!!!


ISOLETTES

Isolettes provide a controlled, enclosed environment for the neonate.  Most NICUs use only double-walled isolettes. This reduces insensible water loss and decreases radiant heat loss,  thus providing less temperature fluctuation when the isolette doors are open.  The two modes of temperature control that may be used are skin temperature control and air temperature control

When using the skin temperature control mode -

Isolette temperature setting should be set at 36.5o-37oC.

If the probe becomes disconnected from the skin, the isolette will continue to heat possibly overheating the infant. 

If the probe becomes covered with a diaper or blanket, cooling may occur since the probe will sense that the infant is warmer than his true body temperature. 

Nursing care includes -

Taping the temperature probe to the infant's abdomen when lying in the supine position and to the infant's lower back when lying in the prone position

Placing the probe close to the spleen or liver since they are highly vascular areas

Avoiding placement of the probe on extremities and bony surfaces.  This gives a false temperature reading which may lead to overheating the infant.


When using the air temperature control mode, the isolette temperature needs to be set within the infant's NTE.

To select the appropriate NTE for an infant -

Take the infant's weight and age in days and look at the following chart.  This will give the nurse a temperature range for the NTE and a starting "set point.”


HEAT LAMPS

Heat lamps are a good tool to help with rewarming babies. However, the lamb needs to be about 28 inches away from the baby. The baby's temperature should also be reassessed at least every 30 minutes.

Goose neck lamps may be used as a heat source. However, this type of lamp gets hot very quickly and can burn the baby if not carefully monitored. Make sure the lamp is at least 18 inches away from the baby.


ADDING CLOTHING

Using a hat to cover the infant’s head helps to reduce heat loss sincet the head is the largest part of the infant's anatomy and is a large source of heat loss. 

Adding layers of clothing may also help to insulate the baby. T-shirts, socks, and sleepers are clothes that may be easily layered.

One drawback to adding clothes is that it decreases the infant's visibility.


THERMAL WARMING PADS

Thermal warming pads are another tool to help maintain the baby's temperature. However, some institutions require an order from the medical team.

Use caution when using thermal warming pads!!!

The premature baby's skin is thinner than the term newborn's skin and burns easily.

Make sure the warming pad is well covered with a double-folded blanket before placing the baby's skin in contact with the pad.

Chux pads are not appropriate to cover the warming pad! There is a plastic leak prevention liner on this type of pad, and the pad can stick to the baby's skin as it becomes to warm.