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Can Real-Time Temperature Monitoring Help Clinicians Save Preemies?

January 16, 2015
by Rajiv Leventhal
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Study done by Duke and Philips could pave the way for new technology to become the standard of care for premature infants

Despite progress in healthcare, statistics show that more than 1 million children under age 5 die due to premature birth every year, around the globe. While the numbers may not be as high in the U.S., it is still a cause of death that is preventable. More specifically, low birth weight premature infants remain especially vulnerable to hypothermia and associated morbidities and mortality.

In fact, infants born below 1,500 grams (3 lbs. 3 oz) in weight often experience hypothermia after birth, due to a metabolic inability to keep warm while their bodies lose heat during initial stabilization. Temperature changes can be sudden and dramatic, and skin temperature sensors or axillary spot checks may not accurately reflect internal changes. As such, continuous core temperature monitoring has been a challenge for caregivers due to lack of access to accurate and comfortable measurement devices designed specifically for very low birth weight preemies.

To this end, just recently, the Duke University School of Nursing announced a research collaboration to execute what officials say is a first-of-its-kind study on the impact of continuous core temperature monitoring on very low birth weight infants. The study will use Philips InnerSense, a dual-function device that embodies an esophageal temperature probe and a feeding tube to continuously monitor the infant’s core temperature from birth through the first 24 hours of life. The device takes temperature technology to the core of your smallest neonates and shows you temperature changes, in real time, Philips officials say.

The Philips-Duke study, “Temperature Monitoring with InnerSense Esophageal Oral Gastric Tube After Birth Through Stabilization in Very Low Birth Weight Infants,” will be conducted over two years and look at 160 premature infants, with enrollment starting this month. According to Robin Dail, Ph.D., R.N., of the Duke University School of Nursing, and lead researcher for the study, the continuous monitoring of temperature for premature infants—weighing up to 1,500 grams at birth—is incredibly challenging for several reasons. For one, this specific population is so thin, and with very little fat, measuring the internal temperature can be difficult.

“I have been in neonatal intensive care unit [NICU] nursing for 30 years, and as a nurse and a nurse practitioner, you always worry how cold the baby really is, especially if the skin temperature is hypothermic,” she says. “You can get the temperature, but when they’re [covered up], the temperature might not read correctly. The thermistor falls off or doesn’t stick since the infant is wet from amniotic fluid, so you might not get the correct reading,” she explains. As such, Dail says there has never been a real good way to assess temperature during all of these procedures. “You would have to stop procedures to get a good temperature reading, and in the delivery room, we don’t do that.”

Robin Dail, Ph.D., R.N.

But Dail notes, with this study, the researchers hope to demonstrate how continuous, real-time temperature monitoring can provide clinicians with a wealth of information on the infant’s condition, helping to prevent hypothermia and provide optimal care. For the trial, the InnerSense tube will be placed through the infant’s mouth into the stomach while in the delivery room, Dail explains. The baby will get weighed and the care coordinators will do the normal ABCs of resuscitation to make sure his or her weight and heart rate are fine.

The baby is then put into a plastic bag up to his or her neck to keep warm. The tube will be stuck down the baby’s mouth, and attached to a square research monitor that will display continuous temperature, Dail says. Finally, the baby will be transferred back to NICU and that temperature display will stay there for the first 24 hours of life. The other half of the babies will get “standard of care,” meaning taking temperature according to admission protocol, she says.

“My hypothesis is that the continuous temperature display will tell us when the baby is cold, so nurses and doctors can do things to warm the baby up. I am also hypothesizing  that when the baby gets to NICU, and the first temperature will be taken under the arms, that the babies in intervention will be warmer, with less instances of hypothermia, compared to the group getting the standard of care.”

Premature babies are a very unique population that requires consistent monitoring, and with such access, clinicians can intervene and make critical decisions at the time of need and ultimately save a preemie’s life. Additionally in the long run, clinicians are also able to narrow in on a better course of treatment based on data from patient population, Dail notes.

Ultimately, she says she would like the American Academy of Pediatrics to adopt this method as the standard of care for treating preemies. Dail recalls leading one of the first studies that put infants in plastic bags to keep them warm. That went a long way in decreasing hypothermia, and she hopes this study will have the same effect.  “In this population, hypothermia is a common problem and can lead to mortality,” she says. “We think that the continuous monitoring and temperature display can decrease mortality. I really think this can be revolutionary.”

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