Work notes: Thermoregulation of the newborn + Skin assessment

When should a neonate be transferred to radiant warmer?

What is the recommended room temp?

If body temp is less than 97.7, despite skin-to-skin

• Notify provider if temp is below 97.0 F or failed attempts to rewarm + notify if temp above 100.4 F

  • Verify if the baby is dressed appropriately for the environment first

72-80 degrees F

When can newborn have 1st bath?

1st bath can be done after 12 hours of birth for term infants (37 weeks + once newborn is thermally + cardiorespiratory stable

• Delay 1st bath to 24 hours for late preterm infants

• Bathing may be delayed to promote bonding or at parent’s request

If mom is HIV + or positive for other infections, newborn is born as soon as stable

What to do if newborn’s temperature is 99.5 F?

• Remove hat and/or covers + uncover if fully clothed

• Control environment temp

  • Rectal temp may be obtained after interventions + repeatedly high axillary temps (3 attempts but check orders first)

Daily care of newborn?

• Only weigh newborn if stable to avoid cold stress

• Bathe newborn every 3 days (encourage parents to participate in bathing activities)

  • Shampoo hair 1-2 times a week

  • Daily bath can be bad for baby’s skin integrity

• Provide frequent monitoring during procedures on radiant warmers, ensuring good temp probe contact + prompt response to equipment alarms

What newborns are at risk for skin injury?

• Infants receiving phototherapy

• Infants requiring adhesives

• Preterm infants

• Infants experiencing withdrawal symptoms

• Infants receiving abx

• Infants receiving higher caloric density (>20 calories per once) breast milk or formula

  • D/t increased stool frequency + contents may cause stool to be more irritating to skin

What are ways to prevent/minimize skin injury of baby?

• At 1st sign of dryness/cracking/fissures, apply cream/ointment at least once a day

• Frequent diaper changes or as soon as soiled

• Assess skin under medical devices

• Replace + rotate monitor leads when soiled/not sticky or w/ any redness noted

• Use skin barriers

  • Ensure barrier is clean + dry + change barrier when soiled or oversatured

  • Limit band aid use

When to notify provider about newborn skin injury?

• New neonatal skin injury

• Existing breakdown becomes worse

  • Treat affected area as directed by provider + request wound consult for skin breakdown if not improving

Document skin breakdown + interventions used to treat in EMR

How should skin protectant be applied to diaper area?

Apply skin protectant to prevent skin breakdown for at risk infant

• Allow skin to air dry after cleansing

• Apply protectant by patting instead of rubbing (causes skin to stretch)

• Use ointments or barrier cream w/ every diaper change

• Consider leaving diaper area open to air @ 1st sign of redness

What are potential causes of diaper dematitis?

• Increased hydration + irritation

• Frequent stools

• Friction during cleansing

• Meds (diuretics/opioids)

How should bathing newborn be?

• Water temp b/t 100-104 F + bath baby under warmer

• Minimize bathing to <5 mins to reduce hypothermia

• Provide swaddled immersion bathing or tub bathing, as opposed to sponge bathing

How is swaddled bathing done?

• Cover tub in disposable liner, fill w/ warm water (utilizing temp indicator)

• Ensure newborn temp is >98.2 F

• Swaddle newborn (fold each side of blanket over baby) + place in water

  • Can also just place blanket in water

• Uncover one limb at a time to cleanse, replacing swaddle b/f moving to next limb

• Removed infant + place on warm, dry towel for drying

Document each bath in EMR