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Early Skin-to-Skin Care in Extremely Preterm Infants: Thermal Balance and Care Environment
Uppsala universitet, Medicinska och farmaceutiska vetenskapsområdet, Medicinska fakulteten, Institutionen för kirurgiska vetenskaper, Anestesiologi och intensivvård. Uppsala universitet, Medicinska och farmaceutiska vetenskapsområdet, Medicinska fakulteten, Institutionen för kvinnors och barns hälsa. (Perinatal, neonatal och barnkardiologisk forskning, Perinatal, Neonatal and Pediatric Cardiology Research)ORCID-id: 0000-0003-0407-2143
Uppsala universitet, Medicinska och farmaceutiska vetenskapsområdet, Medicinska fakulteten, Institutionen för kvinnors och barns hälsa.
Uppsala universitet, Medicinska och farmaceutiska vetenskapsområdet, Medicinska fakulteten, Institutionen för kvinnors och barns hälsa. (Perinatal, neonatal och barnkardiologisk forskning/Hellströlm-Westas)
Uppsala universitet, Medicinska och farmaceutiska vetenskapsområdet, Medicinska fakulteten, Institutionen för kvinnors och barns hälsa. (Barnendokrinologisk forskning/Gustafsson)
Visa övriga samt affilieringar
2012 (Engelska)Ingår i: Journal of Pediatrics, ISSN 0022-3476, E-ISSN 1097-6833, Vol. 161, nr 3, s. 422-426Artikel i tidskrift (Refereegranskat) Published
Abstract [en]

Objective

To evaluate infant thermal balance and the physical environment in extremely preterm infants during skin-to-skin care (SSC).

Study design

Measurements were performed in 26 extremely preterm infants (gestational age 22-26 weeks; postnatal age, 2-9 days) during pretest (in incubator), test (during SSC), and posttest (in incubator) periods. Infants' skin temperature and body temperature, ambient temperature, and relative humidity were measured. Evaporimetry was used to determine transepidermal water loss, and insensible water loss through the skin was calculated.

Results

The infants maintained a normal body temperature during SSC. Transfer to and from SSC was associated with a drop in skin temperature, which increased during SSC. Ambient humidity and temperature were lower during SSC than during incubator care. Insensible water loss through the skin was higher during SSC.

Conclusion

SSC can be safely used in extremely preterminfants. SSC can be initiated during the first week of life and is feasible in infants requiring neonatal intensive care, including ventilator treatment. During SSC, the conduction of heat from parent to infant is sufficiently high to compensate for the increase in evaporative and convective heat loss. The increased water loss through the skin during SSC is small and should not affect the infant's fluid balance.

Ort, förlag, år, upplaga, sidor
2012. Vol. 161, nr 3, s. 422-426
Nationell ämneskategori
Pediatrik
Identifikatorer
URN: urn:nbn:se:uu:diva-182517DOI: 10.1016/j.jpeds.2012.02.034ISI: 000308141700014PubMedID: 22497906OAI: oai:DiVA.org:uu-182517DiVA, id: diva2:560531
Tillgänglig från: 2012-10-15 Skapad: 2012-10-11 Senast uppdaterad: 2018-06-27Bibliografiskt granskad
Ingår i avhandling
1. Aspects of neonatal intensive care and anesthesia: Thermal balance and respiratory management
Öppna denna publikation i ny flik eller fönster >>Aspects of neonatal intensive care and anesthesia: Thermal balance and respiratory management
2018 (Engelska)Doktorsavhandling, sammanläggning (Övrigt vetenskapligt)
Abstract [en]

This thesis is based on four articles originating from three studies conducted in the neonatal intensive care unit and the children’s operating deparment at Uppsala University Hospital, Sweden.

The overall aim was to obtain new knowledge about thermal balance and care environment in extremely preterm infants during skin-to-skin care (SSC), evaluate different methods of intraoperative monitoring of carbon dioxide (CO2), and to investigate how different levels of inhaled oxygen affect infants’ oxygenation during anesthesia and surgery. Study I investigated infant thermal balance and the physical environment for extremely preterm infants during SSC. Study II formed part of a prospective study to assess the performance of non-invasive transcutaneous and end-tidal technique to continuously monitor CO2 levels in the infants blood during anesthesia. Study III was a prospective randomized trial to investigate oxygenation during induction of anesthesia with room air versus high fraction (80%) of oxygen in healthy newborn infants.

The infants maintained normal body temperature during SSC. In comparison to care in an incubator, during SSC ambient humidity was lower and insensible water loss through the skin was higher. Compared to blood gas Pco, transcutaneous carbon dioxide monitoring yielded a bias of 0.3 ± 0.7 kPa, and end-tidal technique a bias of -1.9 ± 0.9 kPa. After intubation, saturation measured by pulse oximetry was lower (p < .05) in the group breathing room air than in the group with high oxygen (93% ± 6.7 and 99% ± 1.5). None of the infants spent time below the pre-specified safety oxygen saturation targets to mandate supplemental oxygen.

This thesis provides new knowledge about early initiation of SSC after birth for extremely preterm infants, the results will be useful to guide safe routines for implementation of early SSC. These results suggest that during anesthesia would transcutaneous monitoring of carbon dioxide be beneficial, end-tidal monitoring correlated poorly to blood gas and induction of general anesthesia in newborn infants can be safely performed without the use of high levels of supplemental oxygen. Taken together, this new knowledge has the potential to improve intraoperative respiratory management.

Ort, förlag, år, upplaga, sidor
uppsala: Acta Universitatis Upsaliensis, 2018. s. 46
Serie
Digital Comprehensive Summaries of Uppsala Dissertations from the Faculty of Medicine, ISSN 1651-6206 ; 1475
Nyckelord
Neonatal, anesthesia, kangaroo-mother-care, skin-to-skin care, carbon dioxide
Nationell ämneskategori
Klinisk medicin
Identifikatorer
urn:nbn:se:uu:diva-352668 (URN)978-91-513-0375-8 (ISBN)
Disputation
2018-09-14, Rosensalen, Akademiska sjukhuset Ingång 95/96, Uppsala, 09:15 (Svenska)
Opponent
Handledare
Tillgänglig från: 2018-08-24 Skapad: 2018-06-27 Senast uppdaterad: 2018-09-07Bibliografiskt granskad

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Karlsson, VictoriaSjörs, GunnarNyqvist, Kerstin HedbergÅgren, Johan

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