Isolettes and phototherapy

[Sfb516]

Hi, I have been working in a level 3 nicu since January. I started this position in January after 9 years of adult oncology. This was a big change for me and I had to take on the mindset of being open to learning everything new. I had a very thorough and excellent 3 month orientation and feel like I'm definitely coming along in my clinical skills and judgement in this new specialty.

HOWEVER... I still struggle with maintaining a baby's temp in an isolette when under intensive photo. When I was orienting I remember my preceptor telling me to set the isolette to ISC for photo so the isolette adjusts itself as necessary according the baby's temp, and that makes sense to me. But this doesn't always work! The other day I had a baby under photo in the isolette on ISC and she kept getting hot. I had to open the doors, move the temp probe, etc and she still wouldn't cool down. A different nurse saw me struggling and told me to switch to TNE because using ISC doesn't always work for regulating the temp with photo. I switched the setting and finally got her temp regulated.

i feel dumb but I don't understand why a baby would still be so hot on ISC. Can someone help explain this to me, and tell me your practice about temp control for phototherapy in isolettes?

[jennylee321]

What was the weight and gestation of the baby ?

[neonn965]

I have never had this issue. My first question is, like above, weight and gestation of the baby. Sometimes the isolette environment is just too warm for a bigger baby, let alone with lights. My next question-- what was the temp probe reading vs. the axillary temp? If the probe is picking up properly the isolette really should lower the air temp in order to accommodate the increasing baby temp (unless it was already at 26 degrees or however low the isolette will go). What was the isolette air temp? That is one of the things I look at, is the air temp appropriate for a baby this size/gestation? If not, why? Finally, was the isolette lowering its own temperature? You had the doors open and such, but why would that be necessary if the isolette was already significantly dropping its own temp? Also, where did you have the temp probe?

Bottom line, in my experience servo mode works just the same under lights. The only thing that might happen is the air temp in the isolette might decrease the keep the baby temp WNL. If that was not occurring then my guess is the temp probe was not picking up properly. And if the isolette temp had already dropped then likely the baby was too big to be in that environment. However, because the baby's temp stabilized on air control that does not seem likely.