Axillary Temperatures in Full-Term Newborn Infants

Friedrichs, Judy B.; Staffileno, Beth A.; Fogg, Louis; Jegier, Briana J.; Hunter, Ramona G.; Portugal, Doreen; Saunders, Jasmine K.; Penner, Janice L.; Peashey, Joelle M.

doi:10.1097/anc.0b013e3182a14f5a

Cited by 9 publications

(7 citation statements)

References 19 publications

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“…This difference in results may be due to the fact that both studies measured skin temperature using different methods (probe versus digital) and at different sites (back/abdomen versus axilla). In the study of Friedrichs et al [10], temperature obtained from the left axilla had higher correlation with rectal measurements as compared to that of the right axilla. Our results also contradict those of Hissink et al [6], Hutton et al [7], and Lee et al [9].…”

Section: Discussionmentioning

confidence: 97%

“…In the seventh study [8], skin temperature measured from the back correlated with rectal measurement better than skin temperature obtained from the abdomen. The level of agreement between the two methods was reported only by Friedrichs, et al [10]. …”

Section: Introductionmentioning

confidence: 98%

“…Subsequently, seven original studies were published revealing controversial results [3, 5–10]. In four studies [5–7, 9] there was poor agreement between rectal and axillary measurements using the Bland-Altman method [11], whereas two studies reported good correlation between axillary and rectal temperature measurements [3, 10]. In the seventh study [8], skin temperature measured from the back correlated with rectal measurement better than skin temperature obtained from the abdomen.…”

Section: Introductionmentioning

confidence: 99%

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Axillary and rectal thermometry in the newborn: do they agree?

et al. 2014

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BackgroundAccurate measurement of body temperature is critical for the assessment of a newborn’s general well-being. In nursery settings, the gold standard rectal thermometry has been replaced by the axillary method. However, evidence pertaining to the agreement between axillary and rectal thermometry in the newborn is controversial. In this cross-sectional study, the agreement between axillary and rectal temperature in newborns, as well as the effects of neonatal, maternal and environmental factors on this agreement were investigated.MethodsThe mean difference between axillary and rectal temperatures was compared in stable term and preterm newborns using paired t-test for the means of differences, Pearson correlation coefficient (r), and the Bland-Altman plot. Stepwise multivariate regression assessed predictors of this difference in the overall group and by gestational age categories.ResultsThe study included 118 newborns with gestational ages ranging from 29 to 41 weeks, median birth weight of 2980 grams (IQR: 2321.3-3363.8). Axillary and rectal temperatures correlated significantly (r = 0.5, p = 0.000) and had similar overall means but differed in 34–36 weeks gestation newborns (p = 0.01). Correlation between both methods increased with advancing gestational age being highest in term newborns (r = 0.6, p = 0.000). Bland-Altman plots revealed good agreement in gestational ages above 29 weeks. The difference between measurements increased with Cesarean delivery (ß = 0.2; 95% CI: 0.02, 0.38), but decreased with advancing chronological age (ß = -0.01; 95% CI: -0.02,-0.01), and with gestational age (ß = -0.05; 95% CI: -0.08,-0.01).ConclusionIn clinically stable term and preterm infants, axillary thermometry is as reliable as rectal measurement. Predictors of agreement between the two methods include gestational age, chronological age and mode of delivery. Further studies are needed to confirm this agreement in sick newborns and in extremely premature infants.

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Section: Discussionmentioning

confidence: 97%

Section: Introductionmentioning

confidence: 98%

Section: Introductionmentioning

confidence: 99%

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Axillary and rectal thermometry in the newborn: do they agree?

et al. 2014

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“…This allowed for limited resolution (hourly) and the need to consider both esophageal and axillary temperatures for more complete and unbiased data. While a recent study suggested that axillary temperatures have limited correlation with core temperature in babies undergoing hypothermia (45), axillary temperature remains the mainstay of temperature monitoring in newborns (46, 47) and has been reasonably correlated to core temperature in other studies (48, 49). Our results were similar when considering only available esophageal temperatures.…”

Section: Discussionmentioning

confidence: 99%

Effect of Temperature on Heart Rate Variability in Neonatal ICU Patients With Hypoxic-Ischemic Encephalopathy

Massaro

Campbell

Metzler

et al. 2017

Pediatric Critical Care Medicine

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Objective To determine whether measures of heart rate variability (HRV) are related to changes in temperature during rewarming after therapeutic hypothermia (TH) for hypoxic ischemic encephalopathy (HIE). Design Prospective observational study. Setting Level 4 neonatal intensive care unit in a free-standing academic children's hospital. Patients Forty-four infants with moderate to severe HIE treated with TH. Interventions Continuous EKG data from 2 hours prior to rewarming through 2 hours after completion of rewarming (up to 10 hours) were analyzed. Measurements and Main Results Median beat-to-beat interval (RRi) and measures of HRV were quantified including RRi standard deviation (SD), low (LF) and high (HF) frequency relative spectral power, detrended fluctuation analysis short- and long- α exponents (αS, αL) and root mean square short- and long- time scales (RMSS, RMSL). The relationships between HRV measures and esophageal/axillary temperatures were evaluated. HRV measures LF, αS, RMSS, and RMSL were negatively associated, while αL was positively associated, with temperature (P<0.01). These findings signify an overall decrease in HRV as temperature increased towards normothermia. Conclusions Measures of HRV are temperature dependent in the range of TH to normothermia. Core body temperature needs to be considered when evaluating HRV metrics as potential physiological biomarkers of illness severity in HIE infants undergoing TH.

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“…We chose the right axillary temperature as a reference because it is less invasive than rectal temperature. There are conflicting results regarding the accuracy and precision of axillary temperature [13,14,15]. However, it has been reported that in 108 term and preterm infants (29-41 weeks of gestation) who were clinically stable, the mean axillary (36.8 ± 0.4°C) and rectal (36.8 ± 0.5°C) temperatures were similar [16].…”

Section: Discussionmentioning

confidence: 99%

Temperature Probe Placement during Preterm Infant Resuscitation: A Randomised Trial

et al. 2017

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Background: Hypothermia on admission to intensive care is associated with poor outcomes in preterm infants. The neonatal resuscitation program recommends the use of servo-control thermoregulation during resuscitation. Very little evidence exists to guide optimal temperature probe placement in the delivery room. Objective: The aim of this work was to determine, in moderately preterm infants, if temperature probe placement in the dorsal, thoracic, or axillary area during delivery room resuscitation would result in differing temperatures on admission to the neonatal intensive care unit (NICU). Methods: A randomised trial with 3 arms was conducted. In total, 122 inborn preterm infants born between 28^0/7 and 35^6/7 weeks of gestational age were recruited. The infants were randomly assigned to thermal probe placement in the left lower back, left upper thorax, or left axilla immediately after birth. Temperature was servo-controlled using an infant resuscitation table set to 36.5°C. The primary outcome was axillary temperature at admission to the NICU before transfer to a closed isolette, recorded with a digital thermometer. The secondary outcomes assessed were temperature within the target range (36.5-37.5°C), hypothermia (<36.5°C), and hyperthermia (>37.5°C). Results: All 122 infants were available for outcome analysis. The groups were comparable for birthweight, gestational age, and sex. The mean admission temperature was comparable between the 3 probe positions (mean, 95% CI): dorsum (36.7°C, 36.6-36.8), thorax (36.8°C, 36.7-36.9), and axilla (36.7°C, 36.6-36.9), p = 0.43. The proportion of infants with admission temperatures in the target range was comparable (87.2, 81.4, and 72.5% respectively), p = 0.44. Conclusion: Dorsal, thoracic, or axillary temperature probe positioning during resuscitation yield similar admission temperatures in moderately preterm infants. Further studies are required in infants below 28 weeks of gestation to determine the best practice.

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Axillary Temperatures in Full-Term Newborn Infants

Abstract: Nurses caring for newborn infants now have evidence showing that temperature-taking in the left axilla is an alternative to using rectal temperatures, possibly minimizing discomfort and potential risk of perforation.

Cited by 9 publications

References 19 publications

Axillary and rectal thermometry in the newborn: do they agree?

Axillary and rectal thermometry in the newborn: do they agree?

Effect of Temperature on Heart Rate Variability in Neonatal ICU Patients With Hypoxic-Ischemic Encephalopathy

Temperature Probe Placement during Preterm Infant Resuscitation: A Randomised Trial

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