Initial newborn temp. rectal or axillary?

[rainrn12]

Working in a community hospital our policy is to take a rectal temp initially to assess rectal patency. The team from the large regional hospital considers this barbaric. I have looked for evidence based research on both methods and have found none.

What does everybody else do?

And what research, standards of care support your policies?

[Jolie, BSN]

I agree with the regional hospital. Having cared for an infant whose intestines were perforated by a rectal thermometer in the newborn nursery, I believe that this practice creates unnecessary risks.

Patency can be assessed by waiting for a first meconium stool. If that hasn't been passed in a timely manner, it is the physician's responsibility to examine the baby for patency. That can be done by introducing the tip of a soft, flexible feeding tube, which is far less likely to cause injury than a rectal thermometer.

Axillary temps are perfectly accurate and are the norm for continuous assessment of newborn infants.

[jenrninmi, MSN, RN]

One hospital I've been at only does axillary. The one I'm at now does rectal. I agree, it's not necessary.

[helloworld]

Rectal, not just for patency, but because it's a more accurate determinant of core temp.

[Mimi2RN, ASN, RN]

Rectal, not just for patency, but because it's a more accurate determinant of core temp.

I agree, axillary temps on newborns can vary a lot from a rectal temp.

As far as patency, why would anyone want to feed a baby with imperforate orifice? There can be a dimple so it looks OK, but no passage through. Why wait to see if anything passes from anywhere else?

[Spidey's mom, ADN, BSN, RN]

I agree, axillary temps on newborns can vary a lot from a rectal temp.

As far as patency, why would anyone want to feed a baby with imperforate orifice? There can be a dimple so it looks OK, but no passage through. Why wait to see if anything passes from anywhere else?

I agree - rectal temps don't have to be done in such a way that it perforates anything. Just barely in gets a valid temp.

We do rectal temps first.

steph

(Hi Mimi!)

[Jolie, BSN]

I agree with Mimi and Steph that the thermometer barely needs to be inserted to assess anal patency. But the same information can be usually be gained with careful visual inspection, and if any question remains, it is much safer to insert a soft, flexible feeding tube than a rigid thermometer.

In hospitals where rectal temps are preferred, are all temps during the baby's stay taken that way? If not, why not?

I understand that rectal and axillary temps can vary quite a bit, but disagree that axillary temps are less informative. Newborns are at risk for cold stress in the first hours and days of life. An axillary temp. will reflect superficial temp. changes (either over-cooling or over-heating) more readily than a rectal one.

I know that intestinal perforation is a rare complication of rectal temps. Thankfully, I have only seen it once, but find it interesting that the perforation occurred during an initial assessment by a nurse, not a temp. taken by an unskilled, nervous parent. It just seems like an un-necessary risk.

[Spidey's mom, ADN, BSN, RN]

I agree with Mimi and Steph that the thermometer barely needs to be inserted to assess anal patency. But the same information can be usually be gained with careful visual inspection, and if any question remains, it is much safer to insert a soft, flexible feeding tube than a rigid thermometer.

In hospitals where rectal temps are preferred, are all temps during the baby's stay taken that way? If not, why not?

I understand that rectal and axillary temps can vary quite a bit, but disagree that axillary temps are less informative. Newborns are at risk for cold stress in the first hours and days of life. An axillary temp. will reflect superficial temp. changes (either over-cooling or over-heating) more readily than a rectal one.

I know that intestinal perforation is a rare complication of rectal temps. Thankfully, I have only seen it once, but find it interesting that the perforation occurred during an initial assessment by a nurse, not a temp. taken by an unskilled, nervous parent. It just seems like an un-necessary risk.

Good points . . . . . if I don't trust axillary temps, why don't I do ALL rectal temps?

hmmm . . .

steph

[pirap]

Our policy requires all temps to be axillary. I would not insert a probe into the orifice of a newborn--not taking that risk. In fact I cannot recall a doctor that has ordered a probe/tube or anything inserted in a neonates orifice. Occasionally I have seen an order for half a glycerin suppository if the baby has not stooled in 24 hours. I usually try to stimulate the orifice first to try to get a stool. Why would anyone risk a perforation? Axillary temps are accurate. If a babes temp is that unstable or there is an issue with the stability of a newborn I would say the baby probably needs to be in intensive with more invasive/accurate monitoring. We do axillary and I have never seen an issue with this.

[crissrn27, RN]

As a nurse that has seen two perfs from rectal temps, and only one imperforate orifice (which was dx by visual, not a rectal temp), I hate rectal temps! We know how they should be done, but does every nurse working with infants? Does every parent? Obviously not. Both of those perfs where caused by RNs in the nursery.

That said, the policy at the hospital where I did newborn nursery was first temp rectal, then axillary, unless low temp, then rectal.

[rainrn12]

Thanks everybody for your input and experiences.

Does anyone know of where evidence based practice, or research articles on this can be found?

I am looking for experiences, and verification on which way is correct, and then present written proof and/or guidelines to change and/or reinforce our current policy.

[BittyBabyGrower, MSN, RN]

An axillary temp is pretty close to core temp, which is what you get if you put an ISC probe over the liver.

Also, an imperforate orifice can be higher up, hence, a rectal temp won't tell you that...the only definate diagnosis...passing meconium.

I've seen 5 kids in the last few years that were transported in with perforations caused by rectal temps, not a pretty sight, and even worse for the parents when they have to take a kiddo home with a colostomy until it heals and can be put back together.