Infants and Hypothermia

scribblerpnp · Aug 20, 2008

I work as a PNP in an office and this is definitely NOT OK.

FIRST I would have taken a rectal temp to make sure that the 92 was the real deal.

THEN this baby would have been admitted for a sepsis workup, warming blanket and also work up for possible thyroid/genetic/metabolic/etc disorders depending on the rest of the exam.

In NO WAY would this baby have been sent home from the office.

allnurses Guide · Aug 20, 2008

I'm wondering if the OP misunderstood something because this scenario is so out of the norm that it seems implausible that a physician would send a baby home with this temp.

Can the OP go back and ask the doc why and get more info?

steph

MissKitty21 · Aug 20, 2008

Thank you all for your replies. I am glad that my concerns weren't unfounded. I did ask around as to why the baby was sent home and only got the response that "all small babies have difficulty regulating body temp." Being new and only a student nurse I figured that a doctor would know better than me.

The baby wasn't lethargic, but she wasn't very active (she's only a week old). She cried when we took blood (which the CBC came back fine?), but otherwise was quiet. She looked pink, except for her toes were cold and cyanotic. The 92 temp. in the office was taken rectally, but the doc. told the mom to take it axillary at home.

I don't know anything else to add. I was just scared when the doc. blew it off, and I am glad my feelings weren't off base or juvenile.

Thank you all for your feedback and concern as well!

allnurses Guide · Aug 20, 2008

Thank you all for your replies. I am glad that my concerns weren't unfounded. I did ask around as to why the baby was sent home and only got the response that "all small babies have difficulty regulating body temp." Being new and only a student nurse I figured that a doctor would know better than me.
The baby wasn't lethargic, but she wasn't very active (she's only a week old). She cried when we took blood (which the CBC came back fine?), but otherwise was quiet. She looked pink, except for her toes were cold and cyanotic. The 92 temp. in the office was taken rectally, but the doc. told the mom to take it axillary at home.
I don't know anything else to add. I was just scared when the doc. blew it off, and I am glad my feelings weren't off base or juvenile.
Thank you all for your feedback and concern as well!

Wow, I really want to talk to that doctor. :confused:

dyrph

Elvish, BSN, DNP, RN, NP · Aug 20, 2008

Thank you all for your replies. I am glad that my concerns weren't unfounded. I did ask around as to why the baby was sent home and only got the response that "all small babies have difficulty regulating body temp." Being new and only a student nurse I figured that a doctor would know better than me.

No, all small babies do NOT have difficulty maintaining their body temp, at least not to that extent. When we get a small baby in the hospital (I work Level 1-2 nursery) we do q3-4hr temps for at least 24 hours. We wrap them up, make a pair of pants out of an upside down tshirt, and keep that dang hat on!!

If none of that works, they go into an isolette and have likely gotten a septic workup by then. Mind you, this is just in days 0-4 of life, generally.

A two-week old baby that can't thermoregulate has got some serious issues.

nurseshepherd · Aug 20, 2008

I did ask around as to why the baby was sent home and only got the response that "all small babies have difficulty regulating body temp." Being new and only a student nurse I figured that a doctor would know better than me. The baby wasn't lethargic, but she wasn't very active (she's only a week old). She cried when we took blood (which the CBC came back fine?), but otherwise was quiet. She looked pink, except for her toes were cold and cyanotic. The 92 temp. in the office was taken rectally, but the doc. told the mom to take it axillary at home.
I don't know anything else to add. I was just scared when the doc. blew it off, and I am glad my feelings weren't off base or juvenile.

Even MORE worrisome; prayer sent for this baby's well being.

allthingsbright · Aug 20, 2008

Wow, you should really follow up on this--I am shocked that this baby's condition would be so neglected. You should really voice your concerns and document somewhere that you did so. That temp is not compatible w/ life, and that baby should have been hospitalized and put in an incubator until stabilized.

nessajune21 · Aug 21, 2008

Just out of curiosity-- How would you test the hypothalamus' ability to thermoregulate?

jeepgirl, LPN, NP · Aug 21, 2008

This may seem silly to ask, but I am throwing it out here.
How concerned would you be if a 5 lb., 1 week old was maintaining her body temp. at only 92?
I understand that hypothermia can put babies at risk for hypoglycemia, decreased perfusion, and even hemorrhage, but the doc. acted like this temp. wasn't too concerning and sent the baby home. Would you be concerned? Why or why not?
Thanks in advance everyone!:redbeathe

could be a number of things but the thing i worry about is sepsis and a couple of other things right off the bat. number one you do a RECTAL to confirm then number to admit straight away.

jeepgirl, LPN, NP · Aug 21, 2008

Thank you all for your replies. I am glad that my concerns weren't unfounded. I did ask around as to why the baby was sent home and only got the response that "all small babies have difficulty regulating body temp." Being new and only a student nurse I figured that a doctor would know better than me.
The baby wasn't lethargic, but she wasn't very active (she's only a week old). She cried when we took blood (which the CBC came back fine?), but otherwise was quiet. She looked pink, except for her toes were cold and cyanotic. The 92 temp. in the office was taken rectally, but the doc. told the mom to take it axillary at home.
I don't know anything else to add. I was just scared when the doc. blew it off, and I am glad my feelings weren't off base or juvenile.
Thank you all for your feedback and concern as well!

no they were not off base.

early in disease, the CBC can be normal. you also have to remember that neonates do not have the same immune response as an adult or even older child does.... heck, they do not even have the same immune response that the INFANT (not being a neonate in the first six weeks of life) does. so this all has to be taken into consideration. not being very active can be a sign of sepsis and other problems. a VERY low core temp like this has to be addressed and the baby should have been a direct admission to the nearest hospital with pediatric services. a lot of neonates will present with a low temp rather than a fever in the presence of sepsis, that is why most babies with this same situation will get a FULL septic workup... not a partial, but a full. no ifs, ands, or buts!

No, all small babies do NOT have difficulty maintaining their body temp, at least not to that extent. When we get a small baby in the hospital (I work Level 1-2 nursery) we do q3-4hr temps for at least 24 hours. We wrap them up, make a pair of pants out of an upside down tshirt, and keep that dang hat on!!
If none of that works, they go into an isolette and have likely gotten a septic workup by then. Mind you, this is just in days 0-4 of life, generally.
A two-week old baby that can't thermoregulate has got some serious issues.

Correct. Not all babies do have difficulty maintaining core body temp. Even if they are small. While smaller and premature babies have fewer fat stores to draw from, usually they are stablized by discharge. This is a main concern with NICU grads, and the professionals caring for these babies are very concerned with each infants ability to regulate temperature when changing the infant from the closed to the open isolette to the crib. They are usually very stable in this regard when discharged from the NICU. Same thing when discharged from well nursery... temps are monitored in well nursery too up until discharge. The fact that the baby was a week old and having these issues is a HUGE concern!!