Observations and monitoring

4.1. Observations and monitoring

An infant who has experienced perinatal compromise may have had an ischaemic insult to the heart, brain, gastrointestinal tract or kidneys and remains at risk in the newborn period. These infants require ongoing evaluation and close monitoring for the first few days following birth. This may necessitate transfer to a higher level of care in some instances.

Any infant who has been intubated and ventilated for resuscitation should not be extubated until the infant is in a nursery and has been carefully assessed.

The neonatal transport team in your state should be consulted early for stabilisation advice and to arrange transfer of the infant to a higher level of care.

In Victoria, PIPER-Neonatal (NETS) can be contacted 24 hours a day on 1300 137 650.

Whilst awaiting the retrieval team, the first priority is to pay close attention to maintaining the infant’s airway, breathing and circulation. If intubated, the endotracheal tube should be left in situ, even if the infant is breathing spontaneously.

Queensland Health staff should refer to the Queensland Maternity and Neonatal Clinical Guideline: Queensland Maternity and Neonatal Guideline: Neonatal Stabilisation for retrieval (Updated 2018). Available via the Queensland Health Clinical Practice Guidelines website.

1. Thermoregulation

Normal range Core
36.5 to 37.5
Skin
0.5 to 1.0 degree lower
Mild hypothermia
36.0 to 36.4
Moderate hypothermia
32.0 to 35.9
Severe hypothermia
<32
  • After birth, a newborn’s skin temperature can drop by by 0.1 to 0.3 0C per minute
  • Effects of cold stress include:
    • Increase in metabolic rate (and energy expenditure) to produce heat through non-shivering thermogenesis
    • An increase in oxygen consumption
    • An increase in glucose utilization

 Thermal management: Radiant warmer/resuscitaire

  • Nurse the infant naked under a radiant warmer.
  • Do not place blankets or towels over the infant: the radiant heat needs to reach the infant.
  • Bubble plastic can be placed over the infant’s body and a hat on the infant’s head.
  • Check the infant’s temperature per axilla at least every 20 minutes until within the normal range, even if using servo-control.
  • Do not over-heat the infant.

Thermal management: Incubator care

  • Set the appropriate neutral thermal environmental temperature according to the infant’s birth weight.
  • Nurse the infant naked for ease of observation (with a nappy on).
  • Check the infant’s temperature per axilla at least every 20 minutes until within the normal range, even if using servo-control.
Birth weight in grams Starting temperature:
Birth to 6 hours		 Range of temperature
< 1200 g
35.0
34.0 – 35.4
 1200 – 1499 g
34.1
33.9 – 34.4
1500 – 2499 g
33.4
32.8 – 33.8
> 2500 & > 36 weeks’
32.9
32.0 – 33.8

Source: Adapted from Merenstein & Gardner (2015) Handbook of Neonatal Intensive Care (8th Ed.).

Previous  Next