Temperature questions and weaning to crib

[chescat58, RNC-NIC]

I have a question(s) that I am posting from one of my co-workers who helps with educaton and policy redefining . I need edvidence based information for all please.

1. what is your specific criteria for weaning an infant to an open crib? Is is a combination of corrected gestational age as well as weight? Currently we base it on weight however looking to see if we need to change the policy.

2. what are temperature recommendations for the actual level 2 nursery? (I think she is looking for a room temperature)

3. If an infant becomes cold during the weaning process to crib, what are the recommendations for increasing the infant's temperature? I am mostly looking for a rate.

Thank you,

Tracey

[AussieTina]

Different country I know, but

1. We put our babes into open cots once they reach 1800gms. Only if they are medically stable of course. We do not take the gestation/ corrected age into account.

2. Our nursery is kept at 25.5 celcius at all times.

3. If they become cold we would then place an overhead heater over them to warm them up.

[chescat58, RNC-NIC]

thank you, will still take what others do as well. As well as any evidence.

[littleneoRN]

25.5 degrees celcius...oh my! That is 77.9 degrees farenheit. I could not work in an environment consistently that warm! We keep our nursery 70-72 typically with a hard limit of no lower than 69 degrees. Sometimes nurses increase the room temperature to keep babies warm, but we really need to know that they will maintain body temperature and gain weight well at a realistic temperature for the home environment. In our climate, most people can't afford to heat their house to 25.5 celcius.

Anyway, I have no evidence, but here is what we do. Wean to open crib at approximately 1800 grams. They must be done needing overhead phototherapy. If infant's are particularly large for age, we may wait, knowing that their neurological maturity will also play a role. We check the infant's temperature hourly. If the temperature is borderline, we may bundle more snugly. Otherwise, the infant will be placed back in an isolette or radiant warmer on servo-control or the previous successful isolette temperature. We are not typically concerned with the speed of rewarming as the infants are not typically significantly hypothermic. The rate of rewarming would be more important for significantly chilled infants, and with our hourly checks initially, this does not occur.

[babyNP., APRN]

Our practice is something like this: Turn the pt's temperature control to servo and wean it by 0.5 to 1 degree every 12-24 hours as tolerated, weaning faster if pt's temperature is above 37 (or some other threshold I can't remember) until you're at the lowest the incubator will go, checking the temperature every 1-2 hours. If the pt's temperature drops below 36.5, consider the weaning failed and not try again for at least 48 hours. I believe it's evidence-based as well; the point is not to stress out the infant so that they use more calories than they should because every calorie being burned is precious.