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Running Head: TO CAP OR NOT TO CAP

To Cap or Not to Cap


Clayton Jensen
Professor Jennifer Stock and Ronda Lucey
NURS*308*01 Nursing: Childbearing Family Sect. 01 14SP
February 3, 2014

TO CAP OR NOT TO CAP

During my time spent at the IMCs Neonatal intensive care unit I have learned more than
I thought I ever would about how precious life is and the care there of. On top of that, my
knowledge of how to take care of such a precious fragile life has not only been greatly improved
but the nervousness of doing just that has now been diminished significantly. Everything thus far
has been followed to a T on what to do and not to do by the nurses, making it an optimal
learning environment and experience. Although, I did have something that really struck me
during my last visit to the unit for clinicals as very peculiar. What I noticed was that none of the
babies in the NICU had baby caps on to help keep them warm. I thought that was funny because
all the babies elsewhere in the hospital most definitely did wear their caps for warmth. So, I
decided to delve deeper into the question and find out for myself what their reasoning was
behind their practice.
My first thought was, being so precise in their work ethic and knowledge of their field I
thought there had to be a good reason for the difference in the nursing staffs practice with such a
fundamental aspect of neonatal care as depicted in nursing literature. From my knowledge of
neonatal care the infants head accounts for a large portion of body surface area and has great
capacity for heat loss, so placing a hat on the infant is an effective way to minimize heat loss
(Olds, 2012, p.768). I also found a study for more information on the matter of regulating baby
body temperature called Evidence-based thermal care of low birthweight neonates Part one by
Turnbull and Petty that found the following:
By reviewing four studies comprising only 350 neonates, concluded that LBW newborns
can be transferred from an incubator into an unheated bassinet or open cot at a weight of
1.6kg following being dressed with a hat and confirmation of a stable central
temperature.

TO CAP OR NOT TO CAP

So, even with the evidence as to why one should place a cap on a babys head to prevent heat
loss, why were these nurses not doing just that? Well, I found another study that explains the
other side of the story. Cheng and Partridge from the Department of Pediatrics, San Francisco
General Hospital, University of California, San Francisco performed a study entitled Effect of
Bundling and High Environmental Temperature on Neonatal Body Temperature which
addresses the possible negative effects of to much heat on a neonatal newborn. They found two
things that are of importance that makes bundling and caps contraindicated. First they said that:
Fever is an important indicator for serious bacterial infection However, determining
whether a temperature elevation is a not always straightforward Bundling and
environmental temperature are frequent explanations for temperature elevations in
neonates in the nursery and outpatient settings, perhaps delaying diagnosis and putting
neonates at increased risk. On the other hand diagnosing a fever when the temperature
elevation is due to exogenous input may cause unnecessary testing and hospitalization.
(1993)
Secondly they found:
Environmentally induced hyperthermia has also been hypothesized to play a role in
sudden infant death syndrome. (1993)
I asked the nurse I was with for the day why they dont provide caps for the neonatal
newborns and said he never really thought about it. He did speak of the fact that they keep the
babies in an isolette first and make sure that they are able to maintain a 37 degree Celsius
temperature prior to taking them out along with other requirements. They want the baby to be
able to do this without a cap to ensure that they will be able to do so in the case they go for a
while without a cap while in the care of the parents later post discharge. This is to protect them

TO CAP OR NOT TO CAP

from allowing the baby to leave before they are ready. He didnt mention anything about fever
diagnosis issues or potential hyperthermia. He just said that it is something they do and that he
was pretty sure it was something the hospital requires of them. He said that was good enough
reason to continue doing it for him.
Concluding, to cap or not to cap is something that I think each hospital takes into their own
hands as to how they would like to handle it. I can definitely see how capping new neonatal
newborns could elevate their temperature in combination with bundling and the isolettes to a
point of a miss diagnosis of fever and even hyperthermia to the point of being a possible factor in
sudden infant death syndrome. I can also understand that babies need the caps for their heat
retention, as they are more prone to loose their heat from their heads. So, in the end I think it is
down to preference as for now, until more studies are done to better assess each side of the
spectrum.

TO CAP OR NOT TO CAP

5
Citations

Cheng, T. L., & Partridge, J. (1993). Effect of Bundling and High Environmental Temperature on
Neonatal Body Temperature. Pediatrics, 92(2), 238.

Davidson, M. R., London, M. L., Ladewig, P. W., & Olds, S. B. (2012). Olds' maternal-newborn
nursing & women's health across the lifespan (9th ed.). Upper Saddle River, N.J.: Pearson
Prentice Hall.

Intermountain Medical Center. (n.d.). Intermountain Healthcare. Retrieved February 4, 2014,


from http://intermountainhealthcare.org

Turnbull, V., & Petty, J. (2013). Evidence-based thermal care of low birthweight neonates. Part
one. Nursing Children & Young People, 25(2), 18-22.

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