Would it shock you to discover that there are more NICU nurses than you might think who cannot explain thermoregulation? Is it alarming to learn that even after they find out how little they know, some NICU nurses have no desire to educate themselves or understand that their lack of knowledge could harm patient outcomes? These realities should concern anyone responsible for caring for NICU patients. This article will discuss the NICU nurse’s responsibility to be proficient in thermoregulation, including the ability to describe what it entails and how it affects NICU patients.
How Important Is Thermoregulation in the NICU?
Thermoregulation, simply put, is the maintenance of a stable body temperature by managing the flow of heat into and out of the body (Speakman, 2004), more specifically, the range of air temperature in which the infant’s body is maintained (Beauman, 2023). This process starts even before the baby is admitted to the NICU. After determining the gestational age—the number of weeks between the first day of the last normal menstrual period and the delivery date—the NICU nurse prepares the isolette or table warmer.
An isolette, a commonly used brand-name incubator, is a warming crib for a critically ill infant, typically between 24-40 weeks. There are many components to an isolette, including the following:
- Two modes of temperature control, servo-control (baby mode) and air control
- Neutral-thermal environment (NTE)
- Humidity
- Skin probe placement and maintenance
- Infection prevention
- Troubleshooting equipment failure
Understanding the difference between servo-control and air control and how the two modes relate to the neutral-thermal environment is a task in itself. This concept can be confusing to a new NICU nurse and is the reason most hospitals provide a three-month orientation. Unfortunately, between the numerous skills to learn, unpredictable dynamics of the NICU, and inconsistent available preceptors, thermoregulation may not be addressed as much as it should be.
However, thermoregulation is one skill a NICU nurse should be well-versed in. An early sign of infection in a NICU patient is an increased NTE, the air temperature inside the isolette; the patient’s core temperature is dropping, and as a result, the isolette’s temperature rises to increase the baby’s core temperature. This process can happen over a 12-hour shift or days, insidiously. Thinking critically and looking at the bigger picture of the patient’s NTE history for hours and days is essential to identifying early causation, such as infection, respiratory distress, or metabolic issues.
Where Are We Going Wrong?
If preceptors are turning off isolettes to cool them down with the patient still inside because they’re panicked that their patient has an increased temperature, we have a serious problem. If a travel nurse comes on shift and cannot find one single thermometer in the NICU, forcing them to search another floor to take their patient’s temperature because the unit only relies on the bed’s skin temperature, we have a problem. If a new NICU nurse asks multiple nurses where to find the thermoregulation protocol before admitting a patient, and no one can answer—even nurses practicing at the same hospital for 20-plus years—we have a problem.
Every NICU should have a thermoregulation protocol based on gestational age. It is imperative that nurses take these guidelines seriously and not guess based on what they’ve witnessed from other nurses. Those nurses could be wrong. Regularly taking axillary temperatures when switching to air control or room air is crucial for a successful transition. Knowing when to put on a hat or a long-sleeve onesie to appropriately give the patient the time they need to regulate their body temperature is considerate to the patient’s and family’s NICU experience.
What Do We Do Now?
The NICU should be the unit with the highest standard of care. We care for patients of the most vulnerable population; their parents depend on us to know what we’re doing. We are professionals. We are the ones families turn to when the doctor leaves the room, and they have no idea what was discussed. We are the ones parents leave their infants with when they leave to go home at night, trusting they’ll be alive in the morning when they return. We have to take it upon ourselves to ask questions and learn whatever is necessary to provide exceptional care. Ensuring every nurse follows thermoregulation protocols is the responsibility of all nurses. Ensuring nurses do not foster a culture of complacency is the responsibility of leadership. Let’s not give our families any reason to doubt that their child is receiving the highest standard of care that they deserve.
References
Beauman, S. S. (2023, August 7). NICU temperature regulation: Best practices for your team. GE HealthCare. NICU Temperature Regulation: Best Practices for Your Team | GE HealthCare (United States)
Manual.jointcommission.org. (2015). Gestational Age. Specifications Manual for Joint Commission National Quality Core Measures. Gestational Age
Speakman, J. R. (2004). Thermoregulation. Encyclopedia of Energy. Thermoregulation – an overview | ScienceDirect Topics