PEDIATRICS Vol. 94 No. 5 November 1994, pp. 669-673
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The Effects of Bundling on Infant Temperature

Geeta Grover MD1, Carol D. Berkowitz MD2, Marita Thompson MD2, Lynne Berry MD2, James Seidel MD, PhD2, and Roger J. Lewis MD, PhD3

1 Department of Pediatrics, University of California, Irvine, Orange, CA
2 Department of Pediatrics, Harbor/UCLA Medical Center, Torrance, CA
3 Department of Emergency Medicine, Harbor/UCLA Medical Center, Torrance, CA

Objective. To determine whether bundling elevates rectal and/or skin temperature of young infants.

Design. Randomized, prospective study stratified by age.

Setting. Clinical Studies Center at a teaching hospital in Los Angeles.

Patients. Sixty-four well, full-term infants (ages 11 to 95 days).

Interventions. Control infants (n = 28) were dressed in a disposable diaper and terry coveralls. Bundled infants (n = 36) were dressed as control infants, plus a cap, a receiving blanket, and a thermal blanket. All infants were monitored in an open crib (room temperature 72° to 75°F). Rectal and skin (anterior mid-lower leg) temperatures and infant states were measured at 5-minute intervals from time 0 to 60 minutes and at 62 and 65 minutes.

Results. The mean skin temperature of bundled infants increased by 2.67°C/hr; mean rectal temperature increased by 0.06°C/hr. The mean skin temperature of nonbundled infants increased by 1.5°C/hr; mean rectal temperature decreased by less than 0.01°C/hr. Comparing bundled infants to nonbundled controls, there was a significant rise in skin temperature (P = .0001) but not in rectal temperature (P > .05, Wilcoxon rank sum test). The study had a power > 98% to detect a rise of .5°C in rectal temperature over 60 minutes. The 95% confidence interval for the change in rectal temperature in bundled infants was -0.03 to + 0.15°C.

Conclusions. Bundling a healthy infant in a temperate external environment causes an increase in skin temperature, but not in rectal temperature. Elevated rectal temperatures should therefore, rarely if ever be attributed to bundling.

Submitted on November 15, 1993
Accepted on February 18, 1994




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