Treatment of Sick Newborns under Radiant Warmers

  • Stephen Baumgart
Conference paper

Abstract

Maintaining core body temperature of premature newborn infants exposed to a hostile extrauterine environment in the modern intensive care nursery is essential for the survival and growth of these delicate patients [1–5]. The concept of a thermal neutral environment for best nurturing such babies has become widely accepted [6–11]. The thermal neutral environment may be defined as the set of environmental conditions (particularly environmental temperature) that results in the minimum expenditure of the infant’s precious metabolic energy reserve to maintain body core temperature within a narrow, homeothermic range (37.2–37.5 °C) [9]. Originally, the thermal neutral environment was described within conventional convection warmed incubators in terms of the optimal air temperature and relative humidity, and the optimal incubator mean wall temperature. Thermal neutral conditions varied for infants of different body weights, and gestational and postnatal ages [9, 10].

Keywords

Toxicity Catheter Quartz Furnace Hydration 

Preview

Unable to display preview. Download preview PDF.

Unable to display preview. Download preview PDF.

References

  1. 1.
    Buetow KC, Klein SW (1964) Effect of maintenance of “normal” skin temperature on survival of infants of low birth weight. Pediatrics; 34: 163.PubMedGoogle Scholar
  2. 2.
    Davies PA, Davis JP (1970) Very low birth weight and subsequent head growth. Lancet; 2: 1216.PubMedCrossRefGoogle Scholar
  3. 3.
    Day RL, Caliguiri L, Kamenski C, et al (1965) Body temperature and survival of premature infants. Pediatrics; 34: 171.Google Scholar
  4. 4.
    Jolly H, Molyneux P, Newell DJ (1962) A controlled study of the effect of temperature on premature babies. J Pediatr; 60: 889.PubMedCrossRefGoogle Scholar
  5. 5.
    Silverman WA, Fertig JW, Berger AP (1958) The influence of the thermal environment upon the survival of newly born premature infants. Pediatrics; 22: 876.PubMedGoogle Scholar
  6. 6.
    Adamson K, Gandy GM, James LS (1965) The influence of thermal factors upon oxygen consumption of the newborn human infant. J Pediatr; 66: 495.PubMedCrossRefGoogle Scholar
  7. 7.
    Scopes JW, Ahmed J (1966) Minimal rates of oxygen consumption in sick and premature infants. Arch Dis Child; 44: 407.CrossRefGoogle Scholar
  8. 8.
    Scopes JW, Ahmed J (1966) Range of critical temperatures in sick and premature newborn babies. Arch Dis Child; 44: 417.CrossRefGoogle Scholar
  9. 9.
    Hey EN (1969) The relation between environmental temperatures and oxygen consumption in the newborn baby. J Physiol; 200: 589.PubMedGoogle Scholar
  10. 10.
    Hey EN, Katz G (1970) The optimum thermal environment for naked babies. Arch Dis Child; 45: 329.Google Scholar
  11. 11.
    Saur PJJ, Dane HJ, Visser HKA (1984) New standards for the neutral thermal environment of healthy very low birth weight infants during the first week of life. Arch Dis Child; 59: 18.CrossRefGoogle Scholar
  12. 12.
    Silverman WA, Sinclair JC, Agate FJ (1966) The oxygen cost of minor changes in heat balance of small newborn infants. Acta Paediatr Scand; 55: 294.PubMedCrossRefGoogle Scholar
  13. 13.
    Bell EF, Gray JC, Weinstein MR, et al (1980) The effects of thermal environment on heat balance and insensible water loss in low birth weight infants. J Pediatr; 96: 452.PubMedCrossRefGoogle Scholar
  14. 14.
    Bell EF, Rios GR (1983) Air versus skin temperature servocontrol of infant incubators. J Pediatr; 103: 954.PubMedCrossRefGoogle Scholar
  15. 15.
    Bell EF, Rios GR (1983) Performance characteristics of two double walled infant incubators. Crit Care Med; 11: 663.PubMedCrossRefGoogle Scholar
  16. 16.
    Agate FJ, Silverman WA (1963) The control of body temperature in the small newborn infant by low-energy infrared radiation. Pediatrics; 31: 725.PubMedGoogle Scholar
  17. 17.
    Levison H, Linsao L, Swyer PR (1966) A comparison of infrared and convective heating for newborn infants. Lancet; 2: 1346.PubMedCrossRefGoogle Scholar
  18. 18.
    Silverman WA, Sinclair JC, Scopes JW (1966) Regulation of body temperature in pediatric surgery. J Pediatr Surg; 1: 321.PubMedCrossRefGoogle Scholar
  19. 19.
    Price HV, Whelpton D, McCarthy J (1971) Newborn infant heater. Lancet; 2: 1294.PubMedCrossRefGoogle Scholar
  20. 20.
    Malin SW, and Baumgart S (1987) Optimal thermal management for low birth weight infants nursed under high-power radiant warmers. Pediatrics; 79:47–54.PubMedGoogle Scholar
  21. 21.
    Williams PR, Oh W (1974) Effects of radiant warmer on insensible water loss in newborn infants. Am J Dis Child; 128: 511.PubMedGoogle Scholar
  22. 22.
    Wu PYK and Hodgeman JE (1974) Insensible water loss in preterm infants: Changes with postnatal development and non-ionizing radiant energy. Pediatrics; 54: 704.PubMedGoogle Scholar
  23. 23.
    Yeh TF, Amma P, Lilien LD, et al (1979) Reduction of insensible water loss in premature infants under the radiant warmer. J Pediatr; 94: 651.PubMedCrossRefGoogle Scholar
  24. 24.
    Bell EF, Neidich GA, Cashore WJ, et al (1979) Combined effect of radiant warmer and phototherapy on insensible water loss in low birth weight infants. J Pediatr; 94: 810.PubMedCrossRefGoogle Scholar
  25. 25.
    Baumgart S, Engle WD, Fox WW, Polin RA (1981) Effect of heat shielding on convective and evaporative heat losses, and radiant heat transfer in the premature neonate. J Pediatr; 99: 948–956.PubMedCrossRefGoogle Scholar
  26. 26.
    Baumgart S, Engle WD, Fox WW, Polin RA (1981) Radiant warmer power and body size as determinants of insensible water loss in the critically ill neonate. Pediatr Res; 15: 1495–1499.PubMedCrossRefGoogle Scholar
  27. 27.
    Baumgart S, Langman CB, Sosulski R, Fox WW, Polin RA (1982) Fluid, electrolyte and glucose maintenance in the very low birthweight infant. Clin Pediatr; 21(4): 199–206.CrossRefGoogle Scholar
  28. 28.
    Baumgart S, Fox WW, Polin RA (1982) Physiologic implications of two different heat shields for infants under radiant warmers. J. Pediatr; 100:787–790.PubMedCrossRefGoogle Scholar
  29. 29.
    LeBlanc MH (1982) Relative efficacy of an incubator and an open warmer in producing thermoneutrality for the small premature infant. Pediatrics; 69: 439.Google Scholar
  30. 30.
    Baumgart S, Knauth A, Casey FX, Quinn GE (1993) Infrared eye injury not due to radiant warmer use in premature neonates. Am J Dis Child; 147: 565–569.PubMedGoogle Scholar
  31. 31.
    Baumgart S, Engle WD, Langman CB, Fox WW, Polin RA (1980) Monitoring radiant power in the critically ill newborn under a radiant warmer. Crit Care Med; 8: 721–724.PubMedCrossRefGoogle Scholar
  32. 32.
    Engle WD, Baumgart S, Langman CB, Fox WW, Polin RA (1980) Radiant energy monitoring and insensible water loss under phototherapy: A new method to study mechanics in fluid balance. Pediatr Res; 14: 596A.Google Scholar
  33. 33.
    Baumgart S, Lavanier J, Schwartz JB, Hall SB (1984) Attenuation of warming and cooling cycles by shielding thermistor probes in infants nursed under radiant warmers. Adv Ther; 1:19–25.Google Scholar
  34. 34.
    Baumgart S (1987) Current concepts and clinical strategies for managing low birthweight infants under radiant warmers. In, Medical Instrumentation; 21: 23–28.PubMedGoogle Scholar
  35. 35.
    Baumgart S (1988) Thermal Regulation. In, Guidelines for Perinatal Care, 2nd Ed. American Academy of Pediatrics and American College of Obstetrics and Gynecology. Evanston, Illinois and Washington, DC.Google Scholar
  36. 36.
    Baumgart S (1991) Thermal regulation in the premature neonate. In, Schaffer & Avery’s Diseases of the Newborn, 6th Ed., Taeusch HW, Ballard RA, Avery ME (eds.), Philadelphia, WB Saunders Company, pp 255–259.Google Scholar
  37. 37.
    Baumgart S (1992) Thermal regulation of the fetus and newborn. In, Neonatal and Fetal Medicine — Physiology and Pathophysiology, 1st Ed. Polin RA and Fox WW (eds), Orlando, WB Saunders Co, pp 477–526.Google Scholar
  38. 38.
    Baumgart S (1992) Incubation of the Human Newborn Infant. In, Issues in Clinical. Neonatology. Pommerance J, Richardson CJ (eds), Norwalk, CT, Appleton & Lange, pp 139–150.Google Scholar
  39. 39.
    Baumgart S (1995) Perinatal and neonatal thermoregulation. In, Intensive Care of the Fetus and Neonate. Spitzer AR (ed), Chicago, Mosby Year Book Inc.Google Scholar
  40. 40.
    Baumgart S (1984) The physiology and physics of heat exchange in the premature newborn infant nursed under a radiant warmer. J Calif Perinat Soc; IV(2): 15–18.Google Scholar
  41. 41.
    Baumgart S (1985) Partitioning of heat losses and gains in premature newborn infants under radiant warmers. Pediatrics; 75:89–99.PubMedGoogle Scholar
  42. 42.
    Baumgart S (1990) Radiant heat loss v radiant heat gain in premature neonates under radiant warmers. Biology of the Neonate; 57:10–20.PubMedCrossRefGoogle Scholar
  43. 43.
    Baumgart S (1984) Physics of heat exchange in the neonatem, Medical Technology for the Neonate. AAP and AAMI Proceedings, Technology Assessment Report #9, pp 1–3, Arlington, VA, 1984.Google Scholar
  44. 44.
    Wheldon AC, Rutter N (1982) The heat balance of small babies nursed in incubators and under radiant warmers. Early Human Development; 6: 131.PubMedCrossRefGoogle Scholar
  45. 45.
    Wheldon AE (1982) Energy balance in the newborn baby: Use of a manikin to estimate radiant and convective heat loss. Phys Med Biol; 27: 285.PubMedCrossRefGoogle Scholar
  46. 46.
    Bell EF, Rios GR (1983) A double walled incubator alters the partition of body heat loss of premature infants. Pediatr Res; 17: 135.PubMedCrossRefGoogle Scholar
  47. 47.
    Okken A, Blijhan C, Franz W, et al (1982) Effects of forced convection of heated air on insensible water loss and heat loss in preterm infants in incubators. J Pediatr; 101: 108.PubMedCrossRefGoogle Scholar
  48. 48.
    Colin J, Houdas Y (1967) Experimental determination of coefficient of heat exchanges by convection of human body. J Appl Physiol; 22: 31.PubMedGoogle Scholar
  49. 49.
    Lewis HE, Foster AR, Cox RN, et al (1969) Aerodynamics of the human microenvironment. Lancet; 1: 7609.Google Scholar
  50. 50.
    Isenschmid Die Bestimmung der Wasserbilanz am Krankenbett. Med Klin Berlin, 1918; 14: 1128.Google Scholar
  51. 51.
    Sosulski R, Polin RA, Baumgart S (1983) Respiratory water loss and heat balance in intubated infants receiving humidified air. J Pediatr; 103:307–310.PubMedCrossRefGoogle Scholar
  52. 52.
    Doyle LW, Sinclair JC (1981) Thermal effect on a Potter baby scale. Pediatr Res; 15: 685.CrossRefGoogle Scholar
  53. 53.
    Damali RA Jr (1981) Insensible weight loss measurements in newborn infants: Possible over estimation with the Potter baby scale. J Pediatr; 99:794.CrossRefGoogle Scholar
  54. 54.
    Lusk G The Elements of the Science of Nutrition, ed 4. Philadelphia, WB Saunders, 1928, pp 64–68.Google Scholar
  55. 55.
    Schulze K, Kairan R, Stefanski M, et al (1981) Spontaneous variability in minute ventilation oxygen consumption and heart rate of low birth weight infants. J Appl Physiol; 50: 1098.PubMedGoogle Scholar
  56. 56.
    Schulze K, Kairan R, Stefanski M, et al (1981) Continuous measurement of minute ventilation and gaseous metabolism of newborn infants. Pediatr Res; 15: 1111.PubMedGoogle Scholar
  57. 57.
    Haycock GB, Schwartz GJ, Wisotsky DH (1978) Geometric method for measuring body surface areas: a height-weight formula validated in infants, children and adults. J Pediatr; 93: 62.PubMedCrossRefGoogle Scholar
  58. 58.
    Fanaroff AA, Wald M, Gruber HS, et al (1972) Insensible water loss in low birthweight infants. Pediatrics; 50: 236.PubMedGoogle Scholar
  59. 59.
    Williams PR, Oh W (1974) Effects of radiant warmer on insensible Water loss in newborn infants. Am J Dis Child; 128: 511.PubMedGoogle Scholar
  60. 60.
    Engle WD, Baumgart S, Schwartz JG, Fox WW, Polin RA (1981) Combined effect of radiant warmer power and phototherapy on insensible water loss in the critically ill neonate. Am J Dis Child; 135(6): 516–520.PubMedGoogle Scholar
  61. 61.
    Engle WD, Baumgart S, Fox WW, Polin RA (1982) Effect of increased radiant warmer power output on state of hydration in the critically ill neonate. Crit Care Med; 10: 673–676.PubMedCrossRefGoogle Scholar
  62. 62.
    Baumgart S (1982) Radiant energy and insensible water loss in the premature newborn infant nursed under a radiant warmer. Clin Perinatol, 9(3):483–503, W. B. Saunders.PubMedGoogle Scholar
  63. 63.
    Bell EF, Weinstein MR, Oh W (1980) Heat balance in premature infants: Comparative effects of convectively heated incubator and radiant warmer, with and without plastic heat shield. J. Pediatr; 96: 460.PubMedCrossRefGoogle Scholar
  64. 64.
    Baumgart S (1984) Reduction of oxygen consumption, insensible water loss and radiant heat demand with use of a plastic blanket for low birthweight infants under radiant warmers. Pediatrics; 74:1022–1028.PubMedGoogle Scholar
  65. 65.
    Knauth A, Gordin M, McNelis W, Baumgart S (1989) A semipermeable polyurethane membrane as an artificial skin in the premature neonate. Pediatrics; 83:945–950.PubMedGoogle Scholar
  66. 66.
    Porat R, Brodsky N (1993) Effect of Tegaderm use on outcome of extremely low birth weight (ELBW) infants. Pediatr Res; 33: 231A.Google Scholar
  67. 67.
    Sliney D, Worbarsht M (1980) Safety with Lasers and Other Optical Sources. Plenum Press, New York, NY; 176: 144.Google Scholar

Copyright information

© Springer-Verlag Berlin 1995

Authors and Affiliations

  • Stephen Baumgart

There are no affiliations available

Personalised recommendations