title: A practical comparison of temporal artery thermometry and axillary thermometry in neonates under different environments.
abstract: OBJECTIVE
  Thermoregulatory stability and monitoring are crucial in neonatal care. However, the current standard of temperature measurement using Axillary Thermometry (AT) poses multiple limitations. Temporal Artery Thermometry (TT) is a promising new method, which thus begs the question: Can TT replace AT in neonates? Previous studies reveal conflicting results, with none involving a Southeast-Asian multi-ethnic neonatal population under different environments.
  
  
  METHODS
  A 6-month prospective comparative study involving neonates managed in a tertiary neonatal centre. Subjects were divided into 4 groups based on the required nursing environment: A) Room air B) Phototherapy C) Radiant warmers D) Incubators. Six hundred and sixty-one paired TT and AT temperature readings were obtained, with concurrent FLACC scoring to evaluate the discomfort associated with each thermometry method.
  
  
  RESULTS
  TT readings were higher than AT in all groups. The mean temperature difference between both methods (TT-AT) was lowest in Group A (0.10 ± 0.19°C), followed by Groups B (0.50 ± 0.33°C), C (0.97 ± 0.76°C) and D (1.15 ± 0.57°C) respectively. Bland-Altman analysis revealed good clinical agreement (± 0.5°C) between both methods in Group A (7-0.27,0.47). However, Groups B (-0.14,1.13), C (-0.51,2.45) and D (0.03,2.27) showed poor agreement. Multiple GEE analysis revealed Malay ethnicity to be an additional predictor of decreased TT-AT ( β = -0.13, p = 0.012). Compared to TT, AT was associated with higher discomfort levels (p <0.001).
  
  
  CONCLUSIONS
  Given the good agreement and increased comfort with TT use, our study confirms that TT is comparable to AT for neonates nursed in room air. TT is therefore recommended for the temperature screening and monitoring of neonates nursed on ambient air. Its use in other environments and factors predictive of comparability of both methods requires further study.
authors.affiliation: Yong Loo Lin School of Medicine, National University of Singapore, Singapore.
authors.forename: Ming Ann
authors.initials: MA
authors.lastname: Sim
authors.affiliation: Department of Paediatric Medicine, KK Women's and Children's Hospital, Singapore.
authors.forename: Syen Yee
authors.initials: SY
authors.lastname: Leow
authors.affiliation: Health Services and Biostatistics Unit, Singapore General Hospital, Singapore.
authors.forename: Ying
authors.initials: Y
authors.lastname: Hao
authors.affiliation: Department of Neonatal and Developmental Medicine, Singapore General Hospital, Singapore.|Duke-NUS Graduate Medical School, Singapore.
authors.forename: Cheo Lian
authors.initials: CL
authors.lastname: Yeo
mesh_terms: D001365:Axilla / Q000502:physiology*; D001831:Body Temperature / Q000502:physiology*; D015331:Cohort Studies; D004777:Environment; D005260:Female; D006801:Humans; D007231:Infant, Newborn; D007363:Intensive Care Units, Neonatal; D008297:Male; D008991:Monitoring, Physiologic / Q000379:methods; D011446:Prospective Studies; D012846:Singapore; D013699:Temporal Arteries / Q000502:physiology*; D062606:Tertiary Care Centers; D013821:Thermometers; D062125:Thermometry / Q000379:methods*
keywords: axillary temperature; neonate; nursery; temporal artery temperature