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Are there people out there still doing rectal temps on neonates?
I hope not - it is contraindicated - to get core temp you need to insert the rectal temp farther than is safe to do - so you risk perforation of the rectum.
From Merenstein and Gardner (1989)... Handbook of Neonatal Intensive
Care..... " The deep body core temp. may be measured by ...esophageal or
tympanic membrane thermometers.... the rectal temp using thermometer or
thermistors must be inserted at least 5 cm to obtain a stable core temp.
This insertion temp risks perforating the rectum in the neonate. The mortality
from rectal perf in the neonate is approx. 70% in reported cases. Safer
and more practical way to measure temp is ... the axilla for 3 minutes,
providing an accurate equivalent of deep body temp. "
Anal atresia will become evident if there are no bowel movement. We no longer recommend rectal temps for ascertaining rectal patency. You can use a soft , flexible catheter if you feel you must do this test of patency prior to waiting for the meconium to pass.
I found another reference:
From Illingworth (1991) He was Emeritus Professor of Child Health at the University of Sheffield,- he died just after submitting the manuscript of this 10th edition of The Normal Child.
p, 105 " The normal temp taken by axilla is up to thirty seven. two
( i can't seem to get some of my numbers to work on this software today
- so I must write them out).. in the mouth it is thirty seven . eight,
and in the rectum thirty eight. It is unwise to take the temp in the mouth
in young children and it is undesirable to take a rectal temp - partly
for psychological reasons, but also because of the slight though frequently
described risk of trauma by fracture of the thermometer. The rectal temp
varies with the depth to which the thermometer is inserted".... & on
p 110." blood in the stool of a baby or older child may be due to the insertion
of a thermometer into the rectum. This is an undesirable procedure and
many cases of perforation of the rectum have been reported."
Determination
of normal ear temperature with an infrared emission detection thermometer.
Chamberlain JM, Terndrup TE, Alexander DT, Silverstone FA, Wolf-Klein
G, O'Donnell R, Grandner J
Ann Emerg Med 1995 Jan;25(1):15-20
The reproducibility of the ear thermometer was better than that of a commonly used electronic thermometer at the oral and axillary sites.
Accuracy
of infrared ear thermometry and traditional temperature methods in young
children.
Erickson RS, Woo TM
Heart Lung 1994 May-Jun;23(3):181-95
The study finds infrared ear (tympanic) thermometers to be more accurate than axillary temperature readings. They also found the use of an ear tug unnecessary for young children and that they were about 0.4 degrees lower than core temperature.
Infrared,
thermistor, and glass-mercury thermometry for measurement of body temperature
in children with cancer.
Shenep JL, Adair JR, Hughes WT, Roberson PK, Flynn PM, Brodkey TO,
Fullen GH, Kennedy WT, Oakes LL, Marina NM
Clin Pediatr (Phila) 1991 Apr;30(4 Suppl):36-41; discussion 49
Department of Infectious Diseases, St. Jude Children's Research Hospital, Memphis, TN 38101-0318.
We conclude that each of these instruments detects fever with comparable reliability. Infrared instruments are especially attractive alternatives due to their time efficiency.
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