Axillary and rectal temperature measurements poorly agree in newborn infants

Rectal and axillary admission temperature in preterm infants less than 32 weeks' gestation, a prospective study

Objectives

The purpose of this research was to evaluate the differences between rectal and axillary temperature measurements in preterm infants who were born less than 32 weeks' gestation using digital thermometers upon their admission to the Neonatal Intensive Care Unit (NICU).

Methods

Prospective, observational, single centre study. Rectal and axillary temperatures measurements were performed using a digital thermometer. The study examined various maternal and neonatal factors to describe the study group, including the use of prenatal corticosteroids, the occurrence of maternal diabetes and hypertension, a history of maternal prolonged rupture of membranes (PROM), maternal chorioamnionitis, the mode of delivery, along with the neonate's gender, birth weight, and gestational age. The Pearson correlation coefficient (R) was calculated to ascertain the linear relationship between the temperatures taken at the rectal and axillary sites. The concordance between the two sets of temperature data was analyzed using the Bland-Altman method.

Results

Eighty infants with a mean gestational age of 28.4 weeks (SD = 2.9) and a mean birth weight of 1,229 g (SD = 456) were included in the study. The mean axillary temperature was 36.4 °C (SD = 0.7), which was lower than the mean rectal temperature of 36.6 °C (SD = 0.6) (p = 0.012). Rectal temperatures surpassed axillary measurements in 59% of instances, while the reverse was observed in 21% of cases. Rectal and axillary temperatures had a strong correlation (Pearson correlation coefficient of 0.915, p < 0.001). Bland-Altman plot showed a small mean difference of 0.1C between the two temperatures measurements but the limits of agreement were wide (+0.7 to -0.6 °C). For hypothermic infants, the mean difference between rectal and axillary temperatures was 0.27 °C, with a wide limit of agreement ranging from -0.5 °C to +1 °C. Conversely, for normothermic infants, the mean difference was smaller at 0.1 °C, with a narrower limit of agreement from -0.4 °C to +0.6 °C.

Conclusions

While there is a good correlation between axillary and rectal temperatures, the wider limits of agreement indicate variability, particularly in hypothermic infants. For a more accurate assessment of core body temperature in hypothermic infants, clinicians should consider using rectal measurements to ensure effective thermal regulation and better clinical outcomes.

Neonatal Admission Temperature in Middle- and High-Income Countries

BACKGROUND AND OBJECTIVES

Despite being preventable, neonatal hypothermia remains common. We hypothesized that the proportion of newborns with hypothermia on admission would be high in all settings, higher in hospitals in middle-income countries (MIC) compared with high-income countries (HIC), and associated with morbidity and mortality.

METHODS

Using the Vermont Oxford Network database of newborns with birth weights 401 to 1500 g or 22 to 29 weeks' gestational age from 2018 to 2021, we analyzed maternal and infant characteristics, delivery room management, and outcomes by temperature within 1 hour of admission to the NICU in 12 MICs and 22 HICs.

RESULTS

Among 201 046 newborns, hypothermia was more common in MIC hospitals (64.0%) compared with HIC hospitals (28.6%). Lower birth weight, small for gestational age status, and prolonged resuscitation were perinatal risk factors for hypothermia. The mortality was doubled for hypothermic compared with euthermic newborns in MICs (24.7% and 15.4%) and HICs (12.7% and 7.6%) hospitals. After adjusting for confounders, the relative risk of death among hypothermic newborns compared with euthermic newborns was 1.21 (95% confidence interval 1.09-1.33) in MICs and 1.26 (95% confidence interval 1.21-1.31) in HICs. Every 1°C increase in admission temperature was associated with a 9% and 10% decrease in mortality risk in MICs and HICs, respectively.

CONCLUSIONS

In this large sample of newborns across MICs and HICs, hypothermia remains common and is strongly associated with mortality. The profound burden of hypothermia presents an opportunity for strategies to improve outcomes and achieve the neonatal 2030 Sustainable Development Goal.

Estimation of neonatal body fat percentage predicts neonatal hypothermia better than birthweight centile

INTRODUCTION

PEA POD™ air displacement plethysmography quickly and noninvasively estimates neonatal body fat percentage (BF%). Low PEA POD™ BF% predicts morbidity better than classification as small-for-gestational-age (SGA; <10th centile), but PEA PODs are not widely available. We examined whether skinfold measurements could effectively identify neonates at risk; comparing skinfold BF%, PEA POD™ BF% and birthweight centiles' prediction of hypothermia - a marker of reduced in utero nutrition.

METHODS

Neonates had customized birthweight centiles calculated, and BF% prospectively estimated by: (i) triceps and subscapular skinfolds using sex-specific equations; and (ii) PEA POD™. Medical record review identified hypothermic (<36.5 °C) episodes.

RESULTS

42/149 (28%) neonates had hypothermia. Skinfold BF%, with an area under the curve (AUC) of 0.66, predicted hypothermia as well as PEA POD™ BF% (AUC = 0.62) and birthweight centile (AUC = 0.61). Birthweight <10^th centile demonstrated 11.9% sensitivity, 38.5% positive predictive value (PPV) and 92.5% specificity for hypothermia. At equal specificity, skinfold and PEA POD™ BF% more than doubled sensitivity (26.2%) and PPV increased to 57.9%.

CONCLUSION

Neonatal BF% performs better to predict neonatal hypothermia than birthweight centile, and may be a better measure of true fetal growth restriction. Estimation of neonatal BF% by skinfold measurements is an inexpensive alternative to PEA POD™.

Accuracy of the Axillary Temperature Screening Compared to Core Rectal Temperature in Infants

Purpose. To compare the sensitivity of axillary and rectal temperature in infants who presents to the emergency department with a recent history of fever. Methods. A single-center cross-sectional comparative study of 201 patients who presents with a recent history of fever. Infants Up to 12 months of age were included. Demographic characteristics such as age and gender, weight, mean axillary and rectal temperatures were documented. Fever is defined as rectal temperature >38°C as opposed to >37.4 in the axillary method. Results. The mean age was 6.1 ± 3.5 months. The mean (SD) rectal-axillary temperature difference was 0.8°C ± 0.7°C which was statistically significant ( P < .001). The sensitivity, specificity, positive predictive and negative predictive values of the axillary method for fever >37.4 were 79.34% (95% CI [73-84.9]), 14.3% (95% CI [0.36-57.9]), 96.2% (95% CI [95-97.2]), and 2.4% (95% CI [0.4-13.5]), respectively. Conclusion. The rectal method remains highly important for accurate and prompt diagnosis in infants.

Delivery Room Interventions for Hypothermia in Preterm Neonates: A Systematic Review and Network Meta-analysis

Importance

Prevention of hypothermia in the delivery room is a cost-effective, high-impact intervention to reduce neonatal mortality, especially in preterm neonates. Several interventions for preventing hypothermia in the delivery room exist, of which the most beneficial is currently unknown.

Objective

To identify the delivery room thermal care intervention that can best reduce neonatal hypothermia and improve clinical outcomes for preterm neonates born at 36 weeks' gestation or less.

Data Sources

MEDLINE, the Cochrane Central Register of Controlled Trials, Embase, and CINAHL databases were searched from inception to November 5, 2020.

Study Selection

Randomized and quasi-randomized clinical trials of thermal care interventions in the delivery room for preterm neonates were included. Peer-reviewed abstracts and studies published in non-English language were also included.

Data Extraction and Synthesis

Data from the included trials were extracted in duplicate using a structured proforma. A network meta-analysis with bayesian random-effects model was used for data synthesis.

Main Outcomes and Measures

Primary outcomes were core body temperature and incidence of moderate to severe hypothermia on admission or within the first 2 hours of life. Secondary outcomes were incidence of hyperthermia, major brain injury, and mortality before discharge. The 9 thermal interventions evaluated were (1) plastic bag or plastic wrap covering the torso and limbs with the head uncovered or covered with a cloth cap; (2) plastic cap covering the head; (3) skin-to-skin contact; (4) thermal mattress; (5) plastic bag or plastic wrap with a plastic cap; (6) plastic bag or plastic wrap along with use of a thermal mattress; (7) plastic bag or plastic wrap along with heated humidified gas for resuscitation or for initiating respiratory support in the delivery room; (8) plastic bag or plastic wrap along with an incubator for transporting from the delivery room; and (9) routine care, including drying and covering the body with warm blankets, with or without a cloth cap.

Results

Of the 6154 titles and abstracts screened, 34 studies that enrolled 3688 neonates were analyzed. Compared with routine care alone, plastic bag or wrap with a thermal mattress (mean difference [MD], 0.98 °C; 95% credible interval [CrI], 0.60-1.36 °C), plastic cap (MD, 0.83 °C; 95% CrI, 0.28-1.38 °C), plastic bag or wrap with heated humidified respiratory gas (MD, 0.76 °C; 95% CrI, 0.38-1.15 °C), plastic bag or wrap with a plastic cap (MD, 0.62 °C; 95% CrI, 0.37-0.88 °C), thermal mattress (MD, 0.62 °C; 95% CrI, 0.33-0.93 °C), and plastic bag or wrap (MD, 0.56 °C; 95% CrI, 0.44-0.69 °C) were associated with greater core body temperature. Certainty of evidence was moderate for 5 interventions and low for plastic bag or wrap with a thermal mattress. When compared with routine care alone, a plastic bag or wrap with heated humidified respiratory gas was associated with less risk of major brain injury (risk ratio, 0.23; 95% CrI, 0.03-0.67; moderate certainty of evidence) and a plastic bag or wrap with a plastic cap was associated with decreased risk of mortality (risk ratio, 0.19; 95% CrI, 0.02-0.66; low certainty of evidence).

Conclusions and Relevance

Results of this study indicate that most thermal care interventions in the delivery room for preterm neonates were associated with improved core body temperature (with moderate certainty of evidence). Specifically, use of a plastic bag or wrap with a plastic cap or with heated humidified gas was associated with lower risk of major brain injury and mortality (with low to moderate certainty of evidence).

Comparison of rectal and axillary temperature measurements in preterm newborns

OBJECTIVE

To compare rectal and axillary temperatures in preterm newborns on admission to the neonatal intensive care unit (NICU).

DESIGN

Secondary analysis of data collected in a randomised controlled trial (RCT).

SETTING

Maternity hospital, level 3 NICU.

PATIENTS

Seventy-two newborns <31 weeks who were enrolled in the BAMBINO RCT (A randomised trial of exothermic mattresses to prevent heat loss in preterm infants at birth, ISRCTN31707342).

INTERVENTIONS

Newborns were placed in polyethylene bags and were randomised to placement on exothermic mattresses, or not in the delivery room. All infants had rectal and axillary temperatures measured in immediate succession using a digital thermometer on NICU admission.

OUTCOME MEASURES

Admission rectal and axillary temperatures.

RESULTS

Mean (SD) gestational age was 28 (2) weeks and birth weight was 1138 (374) g. Mean rectal-axillary temperature difference was 0.1 (0.5°C) (range -1.4°C to +1.5°C). Rectal and axillary temperatures differed by ≥0.5°C in 18/72 (25%) infants; axillary temperature was higher than rectal in 6 (8%) and lower in 12 (17%). There was a positive linear relationship between rectal and axillary measurements (Pearson's correlation R=0.84). Applying the Bland-Altman technique, the width of 95% prediction interval was 1.8°C (-0.8°C to 1.0°C) implying that rectal and axillary measurements may vary by up to 1.0°C. Axillary temperature had a sensitivity of 65% when used to detect rectal hyperthermia and 100% sensitivity for hypothermia.

CONCLUSION

Paired rectal and axillary temperature measurements in preterm newborns on NICU admission vary significantly. Axillary temperature was sensitive at detecting rectal hypothermia but not hyperthermia. Axillary temperature may not be an accurate proxy for rectal temperature measurement in all preterm newborns on NICU admission.

Comparing Axillary and Rectal Temperature Measurements in Very Preterm Infants: A Prospective Observational Study

PURPOSE

The agreement between axillary temperature (AT) and rectal temperature (RT) measurements has not been well established in preterm infants. Therefore, our study aimed to evaluate the agreement between AT and RT measurements in very preterm infants.

METHODS

Preterm infants <32 weeks of gestational age were prospectively included. The infants' body temperature (BT) was measured twice a day from day 1 to day 6. A paired t-test and the Bland-Altman method were used to analyze the difference between the AT and RT. A linear regression model was used to explore the effects of environmental factors on the differences of BT between the axillary and rectal measurements and to calibrate the RT according to the AT.

RESULTS

Eighty infants each underwent 6 paired axillary and rectal measurements. The gestational age varied from 22 to 31 weeks (mean 28 weeks). The birth weight varied from 302 to 1,770 g (mean 1,025 g). The AT was significantly lower than the RT. The difference between the RT and AT significantly increased with increasing RT. The AT and RT demonstrated poor agreement overall; however, the RT can be estimated using the AT with the following equation: RT = -4.033 + 1.116 × AT. Environmental factors, including the incubator temperature, incubator humidity, phototherapy, and application of invasive mechanical ventilation did not affect the differences between the AT and RT measurements.

CONCLUSION

AT measurements cannot be interchangeably used with RT measurements in very preterm infants.

Clinical impact of admission hypothermia in very low birth weight infants: results from Korean Neonatal Network

BACKGROUND

Preterm infants have difficulty maintaining body temperature after birth. However, clinical guidelines advocate that neonatal body temperature should be maintained at 36.5°C-37.5°C.

PURPOSE

We aimed to investigate the incidence of admission hypothermia in very low birth weight (VLBW) infants and to determine the association of admission temperature with in-hospital mortality and morbidities.

METHODS

A cohort study using prospectively collected data involving 70 neonatal intensive care units (NICUs) that participate in the Korean Neonatal Network. From registered infants born between January 2013 and December 2015, 5,343 VLBW infants born at less than 33 weeks of gestation were reviewed.

RESULTS

The mean admission temperature was 36.1°C±0.6°C, with a range of 31.9°C to 38.4°C. Approximately 74.1% of infants had an admission hypothermia of <36.5°C. Lower birth weight, intubation in the delivery room and Apgar score <7 at 5 minutes were significantly related to admission hypothermia. The mortality was the lowest at 36.5°C-37.5°C and adjusted odd ratios for all deaths increased to 1.38 (95% confidence interval [CI], 1.04-1.83), 1.44 (95% CI, 1.05-1.97) and 1.86 (95% CI, 1.22-2.82) for infants with admission temperatures of 36.0°C-36.4°C, 35.0°C-35.9°C, and <35.0°C, respectively. Admission hypothermia was also associated with high likelihoods of bronchopulmonary dysplasia, pulmonary hypertension, proven sepsis, pulmonary hemorrhage, air-leak, seizure, grade 3 or higher intraventricular hemorrhage and advanced retinopathy of prematurity requiring laser therapy.

CONCLUSION

A large portion of preterm infants in Korea had hypothermia at NICU admission, which was associated with high mortality and several important morbidities. More aggressive interventions aimed at reducing hypothermia are required in this high-risk population.

Skin-to-Skin Care After Birth for Moderately Preterm Infants

OBJECTIVE

To investigate the feasibility and safety of skin-to-skin care after birth for moderately preterm infants.

DESIGN

Prospective cohort study.

SETTING

The study was conducted at the maternity wards and NICUs of three study sites in Norway.

PARTICIPANTS

Ninety preterm infants born vaginally with gestational ages of 32 weeks/0 days to 34 weeks/6 days.

METHODS

Comparison of groups of preterm infants who received skin-to-skin care or conventional treatment in incubators after birth.

RESULTS

Median gestational age and birth weight were similar in the two groups: 33 weeks/5 days versus 34 weeks/3 days (p = .464) and 2,100 versus 2,010 g (p = .519). There were no differences in the first body temperature (p = .841) and blood glucose level (p = .539) between the groups.

CONCLUSION

Early skin-to-skin contact in the delivery room for moderately preterm infants may be feasible and safe.

Microbiologic Agents in Parent-reported Neonatal Fever

We reviewed etiology and outcome of consecutive neonates admitted to a neonatal unit for investigation of parent-reported fever (116 neonates over 24 months). Tympanic temperature was measured at the emergency department (Te) and core temperature at the neonatal unit (Tn). Microbials were isolated in 27 patients (23%); Te and Tn were both <38°C in 13 (48%) of the 27 patients. Microbial isolation was associated with older median age (16.7 vs. 8.0 days, p = 0.004), empirical antibiotic commencement (p = 0.0003) and longer hospital stay (median 8 vs. 4.0 days, p = 0.004). Compared with respiratory viral infection, patients with bacteremia had high C-reactive protein (p = 0.005) and likely to have comorbidity of meningitis (p = 0.077). Te ≥38°C had the highest sensitivity, positive likelihood ratio and positive and negative predictive ratios for bacteremia. Parent-reported fever was associated with a 3% incidence of meningitis, 6% of bacteremia and 9% of urinary tract infection. The majority of neonates with parent-reported fever do not have serious bacterial infection. Nevertheless, recommendations about threshold of antibiotic initiation are difficult, and empirical systemic antibiotic coverage must be commenced in those neonates with Te ≥38°C or elevated C-reactive protein.

Neonatal oesophageal and axilla temperatures in the neonatal intensive care unit care

AIM

To compare oesophageal and axilla temperatures in routine neonatal intensive care unit (NICU) care.

METHODS

Prospective observational study of NICU infants with indwelling oral/nasogastric tubes. Three simultaneous temperature measurements were taken: Physitemp axilla, digital Premie Faichney axilla in predictive mode and Physitemp oesophageal. Temperatures were measured on two separate days.

RESULTS

Fifty infants were studied over a range of gestational ages (median 28.9 weeks, IQR 25.8-30.6 weeks) and birthweights (median 1140 g, IQR 742-1498 g). Mean Physitemp oesophageal temperatures were 0.3 ± 0.1°C (range 0.1-0.6°C) higher than Physitemp axilla temperatures. After adjustment for weight, the Physitemp oesophageal-Physitemp axilla difference remained constant over the average oesophageal-axilla temperature range studied (p = 0.07). Physitemp oesophageal temperatures were not affected by weight (p = 0.2) or postmenstrual age (p = 0.51). Physitemp axilla temperatures decreased with increasing weight (p = 0.03) and postmenstrual age (p = 0.048). The Physitemp oesophageal-Physitemp axilla difference was greater for infants in cribs (mean ± SD = 0.4 ± 0.1°C) than in incubators (mean ± SD = 0.3 ± 0.1°C, p < 0.001). The relationship between oesophageal and digital Premie Faichney axilla temperature was similar to oesophageal and axilla Physitemp temperatures.

CONCLUSION

Over a range of infant temperatures encountered in routine NICU care, oesophageal temperature is higher than axilla temperature, although the difference is small. Axillary temperatures measured by digital thermometers in predictive mode are comparable to core oesophageal temperatures.

Using axillary temperature to approximate rectal temperature in newborns

AIM

Various factors have been shown to potentially affect the difference between axillary and rectal temperature measurements in newborns. We aimed to explore their roles and, if possible, to construct a formula that explained the difference.

METHODS

The study was based on a consecutive sample of 175 infants, with a gestational age of 24-42 weeks, whose rectal and axillary temperatures were measured simultaneously at the neonatal unit at Skaraborg Hospital in Sweden. Data were analysed using multiple regressions.

RESULTS

Premature infants had a significantly smaller mean difference (0.33°C) between rectal and axillary temperatures than full-term infants (0.43°C). Significant associated factors for premature infants were chronological age (p = 0.025), time of day (p = 0.004) and axillary temperature (p < 0.001). For full-term infants, the only significant associated factor was axillary temperature (p = 0.015).

CONCLUSION

Although it is possible to construct a formula that estimates neonate rectal temperature based on axillary temperature with a slightly higher reliability than simply adding a fixed value like 0.4°C, such a formula would be too complex to apply in practice. Adding 0.3°C or 0.4°C to the measured axillary temperature for premature infants or full-term infants, respectively, yields acceptable approximations in most cases.

Unobtrusive Monitoring of Neonatal Brain Temperature Using a Zero-Heat-Flux Sensor Matrix

The temperature of preterm neonates must be maintained within a narrow window to ensure their survival. Continuously measuring their core temperature provides an optimal means of monitoring their thermoregulation and their response to environmental changes. However, existing methods of measuring core temperature can be very obtrusive, such as rectal probes, or inaccurate/lagging, such as skin temperature sensors and spot-checks using tympanic temperature sensors. This study investigates an unobtrusive method of measuring brain temperature continuously using an embedded zero-heat-flux (ZHF) sensor matrix placed under the head of the neonate. The measured temperature profile is used to segment areas of motion and incorrect positioning, where the neonate's head is not above the sensors. We compare our measurements during low motion/stable periods to esophageal temperatures for 12 preterm neonates, measured for an average of 5 h per neonate. The method we propose shows good correlation with the reference temperature for most of the neonates. The unobtrusive embedding of the matrix in the neonate's environment poses no harm or disturbance to the care work-flow, while measuring core temperature. To address the effect of motion on the ZHF measurements in the current embodiment, we recommend a more ergonomic embedding ensuring the sensors are continuously placed under the neonate's head.

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

Background

Accurate 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.

Methods

The 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.

Results

The 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).

Conclusion

In 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.

Temperature measurement in the preterm and term neonate: a review of the literature

The maintenance of a constant body temperature is important to all humans but even more so for newborn babies (neonates), especially those born pre-term. Because accurate measurement of body temperature is an important component of thermoregulation management in the neonate, a review of the literature was undertaken to determine the most appropriate method and site of temperature measurement in both the preterm and term neonate. The available evidence indicates that the axilla remains the most common place for temperature measurement.

Axillary temperatures in full-term newborn infants: using evidence to guide safe and effective practice

PURPOSE

Although the American Academy of Pediatrics and the American Congress of Obstetricians and Gynecologists recommend obtaining temperature in newborn infants via the axilla, controversy still exists whether to obtain rectal or axillary temperatures. Of concern is the risk of perforating the rectum or colon during rectal temperature-taking. The purpose of this study was to explore the accuracy of electronic thermometer measuring temperature in the axilla compared with the rectum in full-term newborn infants.

DESIGN

This was an agreement study involving a purposive sample of newborn infants who were greater than 37 weeks' gestation. The general care nursery was located in a large, urban Midwestern academic medical center, and data collection occurred between May 2010 and August 2010.

METHODS

On admission to the general care nursery, both axillary and rectal temperatures were taken using the FasTemp device by Filac Electronic. Axillary temperatures were taken first, followed immediately by rectal temperature. Descriptive statistics, Pearson correlations, and scatter plots were computed.

RESULTS

In 69 newborns, the mean difference between rectal and left axilla temperatures was 0.23°C. There was a significant correlation between rectal temperature and the body temperature for the left axilla (r = 0.786; P = .01).

CONCLUSIONS

These preliminary data support the use of left axillary temperature measurement in the full-term newborn infant in the first few days of life to provide a safe and accurate alternative to rectal temperatures.

CLINICAL RELEVANCE

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.

Fever in the pediatric patient

Fever is the most common reason that children and infants are brought to emergency departments. Emergency physicians face the challenge of quickly distinguishing benign from life-threatening conditions. The management of fever in children is guided by the patient's age, immunization status, and immune status as well as the results of a careful physical examination and appropriate laboratory tests and radiographic views. In this article, the evaluation and treatment of children with fevers of known and unknown origin are described. Causes of common and dangerous conditions that include fever in their manifestation are also discussed.

A comparison of different methods of temperature measurement by mothers and physicians in healthy newborns

OBJECTIVE

To compare the accuracy of digital axillary thermometer (DAT), rectal glass mercury thermometer (RGMT) and infrared forehead skin thermometer (IFST) measurements made by mothers and physicians in healthy newborns.

METHODS

The body temperature measurements of 120 healthy newborns were made on their 2nd day of life using DAT, RGMT and IFST, first by mothers followed by a designated physician. Correlation analysis was performed for the measurements obtained by mothers and the physician. The presence of a former child or children at home, the educational level of the mother and maternal age were also recorded.

RESULTS

No correlation was observed between the measurements made by mothers and the physician using RGMT (R(2) = 0.096). The temperatures measured by mothers and the physician showed a significant correlation when a DAT and IFST were used (R(2) = 0.923, p < 0.001; R(2) = 0.916, p < 0.001, respectively).

CONCLUSIONS

Difficulty of use and interpretation make RGMTs less practical than DATs and IFST for use by mothers. Measurements with an IFST are obtained from a newborn's forehead in a shorter length of time compared to DATs, which makes it a more practical option.

Rectal versus axillary temperatures: is there a significant difference in infants less than 1 year of age?

There are identified gaps regarding the accuracy of axillary temperatures as a means of predicting core temperatures in infants and children. This article discusses the relationship between rectal and axillary temperatures in infants less than 1 year of age. This quality improvement project evaluated 425 paired temperature measurements in 86 infants admitted to an inpatient pediatric unit over a 2-month period. A correlation analysis showed statistically significant differences between the two measurements. The results of this project promoted the development of a standard of care for temperature measurement at the project facility.

A comparison of different methods of temperature measurements in sick newborns

We aimed to compare the accuracy of digital axillary thermometer (DAT), rectal glass mercury thermometer (RGMT), infrared tympanic thermometer (ITT) and infrared forehead skin thermometer (IFST) measurements with traditional axillary glass mercury thermometer (AGMT) for intermittent temperature measurement in sick newborns. A prospective, descriptive and comparative study in which five different types of thermometer readings were performed sequentially for 3 days. A total of 1989 measurements were collected from 663 newborns. DAT and ITT measurements correlated most closely to AGMT (r = 0.94). The correlation coefficent for IFST and RGMT were 0.74 and 0.87, respectively. The mean differences for DAT, ITT, RGMT and IFST were +0.02°C, +0.03°C, +0.25°C and +0.55°C, respectively. There were not any clinical differences (defined as a mean difference of 0.2°C) between both mean AGMT&DAT and AGMT&ITT measurements. Our study suggests that tympanic thermometer measurement could be used as an acceptable and practical method for sick newborn in neonatal units.

A comparison of axillary with rectal thermometry in under 5 children

BACKGROUND

Body temperature measurement is a crucial clinical assessment in the care of an acutely ill child, especially the under fives. Most temperature measurements in our hospital are done from the axilla.

OBJECTIVE

To study the relationship between temperatures taken in the axilla with those taken in the rectum in febrile and afebrile children less than 5 years.

MATERIALS AND METHODS

Rectal and axillary temperatures were taken concurrently in 400 febrile and 400 afebrile children aged less than 5 years using mercury-in-glass thermometers.

RESULT

The rectal temperature measurements ranged from 38.0 to 41.4°C and 36.4 to 37.9°C in the febrile and afebrile groups of children respectively while the axillary temperatures ranged from 36.7 to 41.0°C and 35.9 to 37.5°C in the febrile and afebrile groups of children, respectively. There were significant differences between the temperatures measured at the two sites in all the age groups studied. There was good positive correlation between the rectal and axillary temperatures. A linear relationship between axillary and rectal temperatures was derived using the simple regression analysis. The equation is: rectal temperature = 0.94×axillary temperature+2.92.

CONCLUSION

Although there's good correlation between axillary and rectal temperatures, significant difference exits between them that cannot be explained by the addition of any single value or any particular equation.