Thermoregulation

Leader25, ASN, BSN, RN · Aug 9, 2018

Thermo neutral regulation as per core guideline, isolette on skin control set at 36.5 getting an air temp 33 or less. weaning begins at 1600-1800,infant dressed,shirt and blanket ,( no hat til outside,gradually lowering air temp (environmental) til 28 is achieved with normal axillary temps over 24 hours.Although sometimes they want them out for circumcision regardless. (crude). If they can not maintain normal temp in crib with extra blanket and hat,then return to isolette, and do gradual weaning after temp stabilises.

MamaBear15 · Aug 9, 2018

Thank you for your response. That is how we did it at my first hospital as well. We are trying to change things, create a policy etc but change is hard. When on servo mode you did not wrap, correct? We use handkerchiefs to swaddle even on servo mode. I have tried to fight against but its the norm for us right now. í ½í¸’

Leader25, ASN, BSN, RN · Aug 10, 2018

servo mode = no wrapping.

and if you notice the giraffe has a small button where you can enter weight,GA,dol, and get an ideal range of the NTE.

MamaBear15 · Aug 10, 2018

Yes!! So eager to change practice. I will bring it up to our CNS as well. Thanks for your input!

**NICU Guy, BSN, RN** · Sep 1, 2018

Skin temp probe control until 1500g. Dress them in clothes and turn isolette to air temp. Lower air temp to 28 degrees over the next 5 days. If baby can maintain temp and has gain weight each of the 5 days, move to crib/bassinette.

NICUismylife, ADN, BSN, RN · Sep 5, 2018

I've worked at hospitals that do it both ways. Currently I work in a large level IV NICU in a children's hospital and we swaddle even tiny babes in isolettes unless there is a specific reason that we need to watch the babe's chest or belly, or if their skin is so gelatinous/thin that they can't tolerate it. If we do need to see chest/abdomen, we still swaddle the legs. It's developmentally appropriate for them to be swaddled whenever possible. It does make the temp probe read a bit higher, but we just increase the bed temp to compensate for that, and maintaining a consistent temp isn't generally an issue.

Our babes stay in isolette on servo until 1800g, and then gradually wean to open crib.

NICUismylife, ADN, BSN, RN · Sep 5, 2018

I should also mention that we have full time NICU-specific OT/PT and developmental care specialists that work with each kid to ensure they are getting the most developmentally appropriate care that is realistic for their current health status. And we have a ton of developmental supplies, there is an entire storage room dedicated to just developmental care items. I was honestly blown away when I came here because I came from a hospital that didn't ever swaddle isolette babes, and is/was really behind as far as developmentally appropriate care goes.

calinicumurse · Jan 24, 2019

On ‎9‎/‎5‎/‎2018 at 2:39 AM, NICUismylife said:
I've worked at hospitals that do it both ways. Currently I work in a large level IV NICU in a children's hospital and we swaddle even tiny babes in isolettes unless there is a specific reason that we need to watch the babe's chest or belly, or if their skin is so gelatinous/thin that they can't tolerate it. If we do need to see chest/abdomen, we still swaddle the legs. It's developmentally appropriate for them to be swaddled whenever possible. It does make the temp probe read a bit higher, but we just increase the bed temp to compensate for that, and maintaining a consistent temp isn't generally an issue.
Our babes stay in isolette on servo until 1800g, and then gradually wean to open crib.

You say your hospital has plenty of developmentally appropriate positioning tools, but you still just swaddle them? I'm lost!

NICUismylife, ADN, BSN, RN · Feb 27, 2019

On ‎1‎/‎23‎/‎2019 at 11:32 PM, calinicumurse said:
You say your hospital has plenty of developmentally appropriate positioning tools, but you still just swaddle them? I'm lost!

No, we don't "just swaddle them." We still use bendy-bumpers to create nests, and frogs and gel pads, prone positioners and everything else, but we definitely swaddle them as well. We have actual swaddle devices, or we can use blankets, but all our babes are swaddled, unless (as I stated in my initial post) we need to see their chest/abdomen, and then, as I mentioned before, we swaddle the legs. And our developmental specialists will round on all our babes and evaluate them and make suggestions too.

vintage_RN, BSN, RN · May 2, 2019

We don’t swaddle any of our little ones, only once they’re old or term babies. How can you assess their belly and skin/colour/breathing without waking them up all the time?