Future Research
My team’s program of research is evolving into three
areas to address neonatal thermal stability and reduce
infant hypothermia. The first area will continue to
explore the link between central and peripheral temperature
and morbidity. Once results from our last
study are reported, we should have enough evidence
to link the irregular time periods of altered vasomotor
tone (when an infant has warmer peripheral temperatures
than central temperatures) with instability
and morbidity. A study will be designed to examine
altered vasomotor tone in relationship to morbidity
such as necrotizing enterocolitis and infection as well
as during blood transfusions in a large multi-center
trial.
Secondly, our team just began a randomized controlled
trial funded by Philips Healthcare to investigate
the use of the InnerSense gastric tube/temperature
probe in 160 VLBW infants to measure
esophageal temperature from birth through stabilization.
In the intervention group, an InnerSense tube is
placed down each infant’s esophagus just after birth
in the delivery room. The tube is then attached to
a small temperature monitor with a continuous display.
Care givers can watch the continuous display for
hypothermic temperatures and react accordingly to
ensure thermal stability during delivery resuscitation
and through stabilization. The InnerSense tube is removed
at 24 hours of age for each infant. The control
group receives standard of care, or temperatures
monitored intermittently with axillary thermometers
or skin surface probes during the delivery room resuscitation
and stabilization in the NICU. The primary
outcome is admission temperature and one
hour temperature means between intervention and
control groups. We hypothesize that infants in the
intervention group will be warmer on admission and
at one hour than the control group infants because
care providers will have a reliable, continuous central
temperature available to facilitate optimal thermal
care. If this trial is successful, the intervention may
become the standard of care in the future.
Lastly, our team is interested in implementing educational
and clinical interventions through collaborative
research in low to moderate resource countries,
such as Rwanda, to decrease the incidence of infant
hypothermia and reduce infant mortality. We have
begun talks with providers in Kigali and will begin
working towards a collaborative working relationship
to better infant outcomes.