• Join over 1.2 million students every month
  • Accelerate your learning by 29%
  • Unlimited access from just £6.99 per month

INTENSIVE CARE OF THE NEWBORN - Neonatal thermoregulation at delivery

Extracts from this document...

Introduction

INTENSIVE CARE OF THE NEWBORN (SUPPLEMENTARY EVIDENCE) Neonatal thermoregulation at delivery Registration NO: 100252125 Module NO : SNM2137/3114 Unit Leader : Angela Thurlby Word Count : 1632 Neonates, especially the premature and small for gestational age are at increased risk of hypothermia (Blake and Murray 2006). Whilst working in the NICU, I have recently cared for a very preterm baby born at 23+6 weeks gestation who was born by caesarean section. The baby was admitted to NICU because of her extreme prematurity and was transferred in a plastic bag on the resuscitaire. At the time of admission of the baby, the core temperature was 36.7 �C. Her skin looked very gelatinous and fragile and was beginning to peel because of the handling required for intubation and line insertions. She was placed in incubator with 80% humidity. The parents were very young and this was their first baby. When they saw her in the incubator for the first time with humidity they seemed very upset and frightened. I tried to explain to them that her baby's skin needed time to mature, and a doctor also explained about the skin and use of humidity. Following this they seemed to settle down. From this incident, I knew I wasn't up to date on the current techniques of thermoregulation, as I didn't know what the purpose of the bag was. ...read more.

Middle

In addition, the new born infant has a larger surface area compared to its mass; hence the very low birth weight infants have greater potential for heat loss (Elabassi et al. 2004), which occurs by conduction, convection, radiation and evaporation (Boxwell 2010). Vohra et al (2004) found that putting small premature babies into a plastic bag from the neck down immediately after delivery, without drying the infant, before placing on a radiant warmer and subsequently drying the head and proceeding to resuscitation prevented heat loss at the delivery of infants < 28 weeks gestation. Lenclen (2002), Bjorkland (2000) and Lyon (2004) also support this. Vohra studied 55 infants, randomised into a wrapped group and non wrapped group. Both groups were stabilized under radiant warmers. The infants in the wrapped group had a significantly higher temperature (36.5 �C) than infants the non wrapped group (35.6 �C). The bag remained in place until the baby was stabilised and admitted to the NICU. This method is cheap, effective and appears to be easily implemented and does not interfere with current practice of resuscitation. The occlusive wrap reduces the convective and evaporative heat loss more effectively than conventional drying and exposure (Vohra 2004). Hence I have learnt the importance of plastic bags, which is used in the NICU. Boxwell (2010) recommends the use of humidity to reduce skin water loss and improve the maintenance of body temperature. ...read more.

Conclusion

Finally, a study by Takayama et al. (2000) examined medical records for 203 healthy, full-term infants. He concluded that 17% of all temperatures between birth and 20 hours of life were in the hypothermic range. All these infants responded to simple interventions, such as bundling or increasing room temperature. Consequently, room temperature and maternal temperature should be assessed when managing hypothermic conditions. The room temperature should be at least 25 �C (WHO 2003). Thus, upon on study, there are a number of strategies that can be used to prevent hypothermia at birth. Due to very thin skin, large surface area relative to body mass, limited substrate for heat production, decreased subcutaneous tissue and an immature nervous system, premature infants are extremely susceptible to hypothermia. Water loss can also be result due to their immature skin. These traits are managed in different ways: putting small premature babies in to a plastic bag from the neck down immediately after delivery, and re-warming by placing under a radiant warmer can prevent heat loss at the delivery of infants <28 weeks gestation; the use of humidity to reduce skin water loss and improve the maintenance of body temperature and to minimise evaporative heat loss; the maintenance of room temperature. These techniques are based on scientific observation and ever increasing knowledge has resulted in improved methods of treatment. In my practice, I continue to discover the importance of putting theory into practice as a nurse in the NICU, and in keeping up to date with the current techniques. ...read more.

The above preview is unformatted text

This student written piece of work is one of many that can be found in our University Degree Nursing section.

Found what you're looking for?

  • Start learning 29% faster today
  • 150,000+ documents available
  • Just £6.99 a month

Not the one? Search for your essay title...
  • Join over 1.2 million students every month
  • Accelerate your learning by 29%
  • Unlimited access from just £6.99 per month

See related essaysSee related essays

Related University Degree Nursing essays

  1. Aspect of Care Essay: The Post-Operative Care Following a Hysterectomy and Bilateral Salpingo-oophorectomy.

    To reduce Chloe's risk of developing DVT, the ICP included a detailed prevention protocol. Pre-operatively she was asked to wear thromboembolic deterrent stockings (TEDs) for the duration of her hospital stay and postoperatively was administered sub-cutaneous heparin. Heparin is used to reduce blood clotting (Sparks, 1996)

  2. The Impact of Policy on Practice-analysis of a critical incident related to interprofessional delivery ...

    care provided by the NHS and social services and moreover reduce 'healthcare associated infections' it has produced a number of guidance documents, which relate to specific and local areas within the NHS. Getting Ahead of the Curve, Winning Ways: Working together to reduce Healthcare Associated Infection in England and Towards

  1. Surgical face mask in modern operating room

    The wound infection rate was found to be 1.8% in unmasked period. Orr's (1981) results showed that the incidence of post-operation wound infection is related to the surgical procedure, as well as other factors such as surgical skill, adequate surgical scrub, appropriate culture material, antibiotic prophylaxis, and correction of dehydration and poor nutrition.

  2. Burns Case Study. The pathophysiology involves both local and systemic responses which Klein ...

    burns are classified by four degrees. The first degree or superficial partial thickness burn only affects the epidermis, the skin is often warm and dry, and wounds typically appear bright pink to red with minimal edema and fine blisters.

  1. The following reflection will analyse the issue of post natal head moulding which has ...

    According to Chan et al (1993) spontaneous head repositioning is not possible until the neck and shoulder muscles develop and the infant's condition improves. The American Academy of Paediatrics (1992) recommended avoiding use of the prone position in order to reduce the risk of sudden infant death syndrome.

  2. Encouraging parental participation in the NICU. According to Wigert et al (2006) the ...

    They then eventually move on to try and recognise how the machines work, interpretation of blood results and showing curiosity in the cause of the baby's problems. Reid (2000) describe that when a mother holds her baby it remains the most momentous event, along with feeding them for the first time.

  1. Broncho Pulmonary Dysplasia. The following discussion will analyse issues related to babies who ...

    However, even with the evidence that giving antenatal dexamethazone to the mother reduces the number of days of ventilator support (Knoppert and Mackengee (1994), Davies and Henderson-Smart (1998), some doctors are reluctant to prescribe it, due to the associated side effects such as neuromotor dysfunction, poor growth, cerebral palsy (Yeh et al1998, Crawford and Hickenson 2002, E.

  2. Essay by trainee practitioner. During my time spent on placement on Intensive Care Unit ...

    but because he was an unknown male the Doctors wanted to give the patient?s family chance to say goodbye to him he remained unknown for 12 hours. The police came to the ward to take his finger prints to try to identify him, but he had no police record.

  • Over 160,000 pieces
    of student written work
  • Annotated by
    experienced teachers
  • Ideas and feedback to
    improve your own work