Comparison of two microenvironments and nurse caregiving on thermal stability of ELBW infants.
Comparison of two microenvironments and nurse caregiving on thermal stability of ELBW infants.
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DOI：
10.1053/adnc.2002.33543
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发表时间：
2002-06-01
期刊：
影响因子：
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通讯作者：
Horns, Kimberly M
中科院分区：
文献类型：
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作者：
Horns, Kimberly M
目得：本研究测试了一种新型生物仪器辐射加温器（RW），旨在提供一个减少干预的护理环境（RINCE），在护理人员中断期间，对极低出生体重（ELBW）婴儿（<1，000 g）的环境和体表温度稳定性。将RINCE与由标准RW组成的对照床进行比较，所述标准RW用树脂玻璃罩（Rohm和哈斯，费城，PA）和外部湿度源进行修改。平均胎龄为25.7周（+/- 1.4周）。出生体重范围为570 - 880 g：平均出生体重为730 g（+/- 95.14 g）。新生儿急性生理学的平均得分为21.4（+/-6）。设计：本临床研究采用小样本、交叉时间序列设计。婴儿在出生后第一天随机分配至治疗顺序（对照床v RINCE）。微环境之间的洗脱期进行了观察，然后每个婴儿被放置到其他condition.METHODS：每个婴儿进行了研究，在每个治疗条件（控制床v RINCE）5小时。腹部皮肤温度，足跟温度，环境温度，和相对湿度（RH）的记录由计算机数据采集系统每60秒为12至24小时的生活。护理人员的干预，微环境破坏，或两者都被手动编码在dataset.PRINCIPAL结果：分钟的平均数腹部温度低于36.5摄氏度是没有显着差异，无论是微环境（P = 0.48）。在RINCE中，足跟温度低于35.2摄氏度和中心-外周差异大于2摄氏度的平均分钟数显著较少（分别为P < 0.04和P < 0.0001）。虽然中断的次数和持续时间（P = 0.71），手术次数（P = 0.30），干预持续时间（P = 0.56）在两种环境中均无显著差异，环境空气温度（P < 0.001）和RH（P < 0.001）在RINCE中的变异性显著降低。这项研究确定了极低出生体重儿的温度和周围环境的极端相互依赖性。RINCE显著改善了环境温度变异性、RH变异性以及婴儿的外周温度和Δ温度（Δ T）稳定性，特别是在护理人员中断期间和之后。
PURPOSE: This study tested a novel bioinstrumented radiant warmer (RW), designed to provide a reduced-intervention nursing caregiving environment (RINCE) on the ambient and body surface temperature stability of extremely low birth-weight (ELBW) infants (< 1,000 g) during caregiver disruptions. The RINCE was compared with a control bed consisting of a standard RW, modified with a Plexiglas hood (Rohm and Haas, Philadelphia, PA) and an external humidity source.SUBJECTS: The sample consisted of 10 extremely low birth-weight infants. The mean gestational age was 25.7 weeks (+/- 1.4 weeks). Birth weight ranged from 570 to 880 g: mean birth weight was 730 g (+/- 95.14 g). The mean Scores for Neonatal Acute Physiology was 21.4 (+/- 6).DESIGN: This clinical study used a small n sample, crossover time-series design. Infants were randomized to treatment order (control bed v RINCE) on the first day of life. A washout period between microenvironments was observed, and then each infant was placed into the other condition.METHODS: Each infant was studied for 5 hours in each treatment condition (control bed v RINCE). Abdominal skin temperatures, heel temperatures, ambient temperatures, and relative humidity (RH) were recorded by a computerized data acquisition system every 60 seconds for hours 12 to 24 of life. Caregiver interventions, microenvironment disruptions, or both were manually coded in the data set.PRINCIPAL RESULTS: The mean number of minutes abdominal temperatures were less than 36.5 degrees C was not significantly different in either microenvironment (P = 0.48). The mean number of minutes that heel temperatures were less than 35.2 degrees C and central-peripheral differences were greater than 2 degrees C was significantly less in the RINCE (P < 0.04 and P < 0.0001, respectively). Although the number and duration of caregiving disruptions (P = 0.71), number of procedures (P = 0.30), and the duration of interventions (P = 0.56) were not significantly different in either environment, the ambient air temperature (P < 0.001) and RH (P < 0.001) were significantly less variable in the RINCE during and after caregiving disruptions.CONCLUSIONS: This study identified the extreme inter-dependence of the ELBW infant's temperature and the ambient environment. The RINCE significantly improved ambient temperature variability, RH variability, and the infant's peripheral and delta temperature (delta T) stability, particularly during and after caregiver disruptions.