Temperature methods in preterm babies

[PAjama_Mama]

Hello all,

I am an ER nurse, but I am posting this here because I would rather get the scoop right from the true experts.

The other day I had a preterm neonate who was born at 34 weeks gestation and was now 2 weeks old come into the ER. I remember being told years ago to never take a rectal temp on a preterm baby due to possible vagal response or bowel perforation and to take an axillary instead.

At what point is it okay to begin taking rectal temperatures in these babies? We only have three options for temperatures in my small ER: Oral, Axillary or Rectal.

[CosmicHymns, BSN, RN]

Rectal is fine but axillary is less than 97.7F. We take them all the time at my hospital but are very mindful about depth and vagal symptoms.

[meanmaryjean, DNP, RN]

We NEVER take rectal temps without a compelling reason. Too much risk. Not worth it. We take axillary and oral on our intubated kids (because they're sedated- otherwise it would never work)

[NicuGal, MSN, RN]

We never do rectal either, unless it is a big chronic baby who is well past term. Axillary is pretty reliable for fevers. There are articles supporting evidence based practice that an axillary temp in the left axillary is very close to a rectal temp, somewhere in the 0.25-0.5C range.

We don't even teach parents rectal temps.

[NICUmiiki, DNP, NP]

We never take rectal temps and neither does the local peds hospital. Axillary for everyone. Axillary correlates well enough with core temp for temp management..

The ER docs didn't really like that idea though. They wanted rectal temps for ingrown toenails.

[NICU Guy, BSN, RN]

We take only axillary temps.

[adventure_rn, MSN, NP]

Same as above. We do one single rectal temp immediately after birth to check for patency; after that it's 100% axillary. Axillary temps are accurate enough for our purposes, primarily assessing thermoregulation. Temp tells us relatively little about neonatal infection; neonates' nervous systems are so undeveloped that their temps may not change at all, or their temps can run cold when sick. For the assessment and care of infection, we're really only interested in labs because they are a much more accurate indicator of infection than temp. Temps are only a way to ensure that a baby's thermoregulation is appropriate.

Peds nurses may be a better resource than NICU nurses about when (or if) to switch to rectal.

PS--I am perpetually amazed by ED nurses. The fact that you care for patients as diverse as a 99-year-old with heart failure to a preemie corrected to 36 weeks gestation is astounding to me!

[NicuGal, MSN, RN]

An initial rectal temp doesn't even guarantee patency since you can have a defect higher up. Only passage of meconium is a sure thing í ½í¸Š

[taliaubc]

I work in Vancouver, Canada and at our tertiary location and everywhere else I know we only take axillary on neonates, and once they become able to take it orally we do.

[NRB41]

Where I'm at is pretty much the consensus of the rest of this thread: absolutely no rectal temps, all axillary.

[Elvish, BSN, DNP, RN, NP]

We also do one rectal temp at birth to establish that they have an orifice (we had an imperforate orifice that got missed, so now....). I agree with the PP who said that it really doesn't establish much because there can always be a blind pouch somewhere higher up.

After that we always do axillary. It tells us enough of what we need to know.