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 Table of Contents  
Year : 2018  |  Volume : 10  |  Issue : 4  |  Page : 115-118

Rectal, axillary, and tympanic temperatures inneonates and infants with or without fever

1 Department of Pediatric Gastroenterology, Tripoli Medical Centre, Tripoli, Libya
2 Department of Pediatric Gastroenterology, Tripoli Medical Centre; Department of Pediatrics, Faculty of Medicine, University of Tripoli, Tripoli, Libya

Date of Web Publication3-Aug-2018

Correspondence Address:
Prof. Fauzi Abdalla Sagher
Department of Pediatric Gastroenterology, Tripoli Medical Centre, Faculty of Medicine, University of Tripoli, Tripoli
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Source of Support: None, Conflict of Interest: None

DOI: 10.4103/ijmbs.ijmbs_26_18

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Objectives: To evaluate the agreement between temperature measured at the axilla or tympanic to rectum using standard techniques. Patients and Methods: We studied 50 neonates and 50 infants admitted to special care baby unit and Pediatric Gastroenterology Department with or without fever. Preterm, sick, malnourished neonates and uncooperative and crying infants were excluded from the study. Verbal consent from mothers was taken before the measurements. To adjust for rectal temperature, 0.55°C added to neonates and 0.65°C to infants' axillary temperature, 0.1°C to neonates, and 0.45°C to infants' tympanic membrane temperature. Results: There was a strong correlation (r) between 0.79 and 0.89 for axillary temperature with rectal temperature in neonates and infants, males and females, and for tympanic temperature with rectal in male infants. However, moderate correlation (r) was between 0.73 and 0.76 for tympanic temperature with rectal temperature in overall neonates and male and female infants. Axillary temperature missed 1% of pyrexia cases, whereas tympanic membrane measurements overestimate pyrexia in 5% of cases. Conclusion: It is safe reliable and convenient to use the axillary route for measurements of temperature in neonates and infants with or without fever.

Keywords: Axillary, fever, rectal, temperature, tympanic

How to cite this article:
Shagleb AA, Saad ZA, Sagher FA. Rectal, axillary, and tympanic temperatures inneonates and infants with or without fever. Ibnosina J Med Biomed Sci 2018;10:115-8

How to cite this URL:
Shagleb AA, Saad ZA, Sagher FA. Rectal, axillary, and tympanic temperatures inneonates and infants with or without fever. Ibnosina J Med Biomed Sci [serial online] 2018 [cited 2022 Aug 10];10:115-8. Available from: http://www.ijmbs.org/text.asp?2018/10/4/115/238523

  Introduction Top

Body temperature is usually measured to confirm the presence or absence of fever.[1] The presence of fever in infants and neonates affects the decision of both parents and clinicians.[2],[3] Parents may take vigorous steps to lower their children's temperature before and after seeking medical advice,[2],[3] and clinicians may carry out unnecessary investigations, may admit the child to the hospital,[2],[3],[4] or just send him/her home with or without antibiotics.[3] On the other hand, an incorrect temperature measurement could result in delayed detection of serious illness or an unnecessary septic workup.[1] Despite the plethora of instruments that have become available in the past 30 years, these remain considerable controversy as the most appropriate thermometer and the most anatomical site for temperature measurement of neonates, infants, and children.[1] An ideal thermometer should accurately reflect 40. 41 core body temperature in all age groups, be convenient, easy, and comfortable to use by patient and practitioner, without causing embarrassment, and give a rapid result and does not result in cross-infection “safe,” influenced by ambient temperature, and cost-effective. We aimed to compare the temperature measured by axillary and tympanic with rectal routes in neonates and infants with or without fever.

  Subjects and Methods Top

This prospective study was carried out on 50 infants and 50 neonates admitted in the pediatric ward and special care baby unit, respectively, in Tripoli Medical Center for 3 months from June 1 to August 31, 2009. Children above 1 year and infants who were uncooperative or crying, preterm, or malnourished were excluded from the study. Each neonate and infant underwent simultaneous temperature measurement through the rectum, axilla, and external auditory canal “tympanic” for at least 3 min. The rectal and axillary measurements were performed using mercury in glass thermometer (IE. Medical-CE0123), using standard technique; for rectal measurement, a small amount of lubricant applied to the end of the probe which is gently slided into the rectum for about 2–2.5 cm.). The tympanic measurements were performed using digital auditory canal tympanic membrane thermometer (infrared ear thermometer, Braun ThermoScan. IRT 4520), calibrated before each measurement. Consent was obtained from the mothers after explaining the study. Statistical analysis was carried out using SPSS (IBM Corp. Released 2015. IBM SPSS Statistics for Windows, Version 23.0. Armonk, NY: IBM Corp.). Analysis of means (standard deviation), median (range), median difference, and correlation coefficient for measurements were calculated for each site for neonates and infants with or without fever in both genders.

  Results Top

A total of 100 patients (50 infants and 50 neonates) were included in the study. Measurements of rectal, axillary, and tympanic were taken at the same time. For neonates, 0.55°C added to axillary temperature with a strong correlation coefficient of 0.84 and 0.1°C added to tympanic temperature with a moderate correlation coefficient (0.74). [Table 1] also shows that 0.65°C added to the axillary temperature of the infant to adjust for the rectal one and 0.45°C added to tympanic temperature. There was a strong correlation between rectal and axillary and between rectal and tympanic measurement in infants 0.88 and 0.83, respectively.
Table 1: Relationship of the rectal, axillary, and tympanic temperature of all 50 neonates and 50 infants

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When gender is considered, we found that 0.6°C and 0.5°C added to axillary temperature of male and female neonates, respectively, to adjust for rectal ones with a strong correlation between axillary and rectal temperature (r = 0.84, 0.90) in both male and female neonates and 0.2°C added to tympanic temperature of male neonates to adjust for rectal one with a moderate correlation between tympanic and rectal temperature in male and female neonates (r = 0.75, 0.74) [Table 2].
Table 2: The relationship of the rectal, axillary, and tympanic temperature by gender neonates (29 males and 21 females) and in infants (33 males and 17 females)

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For infants, 0.6 C added to the axillary temperature of male infants and 0.7°C to the axillary temperature of female infants to adjust for rectal ones with a strong correlation between the axillary and rectal temperature of male and female infants (r = 0.89, 0.79), respectively. Furthermore, 0.4°C added to male infants with a strong correlation of 0.84 and 0.5°C to female infants' tympanic membrane temperature to adjust for rectal ones, with a moderate correlation of 0.73 [Table 2].

When rectal temperature of 38°C was taken as a cutoff point for fever, we found that only 6% of all neonates and infants had fever. Of these, the axillary measurement could detect 5%, i.e., axillary temperature missed 1% of the cases with pyrexia. On the other hand, tympanic measurements detect 11%, i.e., it overestimates core temperature by 5% [Table 3].
Table 3: Relation of fever to rectal, axillary, and tympanic measurements

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  Discussion Top

Rectal route is considered the gold standard for evaluations of temperature and to make clinical decisions. However, the temperature can be measured at more convenient sites including tympanic membrane, skin, oral, and axilla, with a conversion factor adjusted to estimate rectal temperature.

The accurate temperature measured is critical in infants, especially under the age of 3 months; in this age group, a temperature over 38°C has been associated with serious bacterial infection in 3%–15% of patients.[5]

In the present study, tympanic measurements in neonates were not sufficiently accurate with low sensitivity in agreement with several previous studies.[6],[7],[8] This is in contrast with other workers who concluded that tympanic thermometry is a very promising, acceptable, and practical methods and seems to be sufficient for mothers.[9],[10],[11] Tympanic thermometry in infancy does not show sufficient agreement with a rectal one,[2] supported by a recent meta-analysis and systematic review study by Zhen et al. 2014.[12] They concluded that the accuracy of ear thermometer in children is poor and cannot replace rectal in agreement with our findings but at variance with other studies.[1],[13],[14],[15],[16],[17]

Several studies showed that axillary measurements in the newborn are interchangeable with rectal temperature [3],[7],[18],[19],[20],[21] which in agreement with our results, but Hissink Muller, in 2008,[22] concluded that axillary and rectal temperature measurements poorly agree in newborn infants and cannot be used interchangeably.

The axillary temperature in infancy is safe; the corrected axillary temperature is a good guide to the rectal temperature in patients older than 1 month,[23] which is in favor of our results. Other studies [2],[14],[16] concluded that axillary temperature does not reflect rectal temperature, and there was a wide variation between axillary and rectal readings. In our study, only 6% were feverish by rectal route; further studies are required to assess the relationship between the axillary and rectal temperature in feverish neonates and infants of different pathologies. Our study also showed some gender variation, which requires further elucidation in large scale to confirm it and to find an explanation.

  Conclusion Top

It is safe reliable and convenient to use the axillary route for measurements of temperature in neonates and infants with or without fever.


The authors express their gratitude to Dr. R K Pal of the Department of Community Medicine for his help in the statistical analysis.

Authors' contribution

All authors contributed to the conception and conduct of the study, preparation, revision, and approval of the final version of the manuscript.

Compliance with ethical principles

The study was approved by the Ethical Committee at the Tripoli Medical Center, Tripoli, Libya. Parents of all participants gave a verbal informed consent before participation.

Financial support and sponsorship


Conflicts of interest

There are no conflicts of interest.

  References Top

El-Radhi AS, Barry W. Thermometry in paediatric practice. Arch Dis Child 2006;91:351-6.  Back to cited text no. 1
Craig JV, Lancaster GA, Williamson PR, Smyth RL. Temperature measured at the axilla compared with rectum in children and young people: Systematic review. BMJ 2000;320:1174-8.  Back to cited text no. 2
Haddadin RB, Shamo'on HI. Study between axillary and rectal temperature measurements in children. East Mediterr Health J 2007;13:1060-6.  Back to cited text no. 3
Thomas V, Riegel B, Andrea J, Murray P, Gerhart A, Gocka I, et al. National survey of pediatric fever management practices among emergency department nurses. J Emerg Nurs 1994;20:505-10.  Back to cited text no. 4
Baskin MN, O'Rourke EJ, Fleisher GR. Outpatient treatment of febrile infants 28 to 89 days of age with intramuscular administration of ceftriaxone. J Pediatr 1992;120:22-7.  Back to cited text no. 5
Davis K. The accuracy of tympanic temperature measurement in children. Pediatr Nurs 1993;19:267-72.  Back to cited text no. 6
Yetman RJ, Coody DK, West MS, Montgomery D, Brown M. Comparison of temperature measurements by an aural infrared thermometer with measurements by traditional rectal and axillary techniques. J Pediatr 1993;122:769-73.  Back to cited text no. 7
Duru CO, Akinbami FO, Orimadegun AE. A comparison of tympanic and rectal temperatures in term Nigerian neonates. BMC Pediatr 2012;12:86.  Back to cited text no. 8
Sollai S, Dani C, Berti E, Fancelli C, Galli L, de Martino M, et al. Performance of a non-contact infrared thermometer in healthy newborns. BMJ Open 2016;6:e008695.  Back to cited text no. 9
Uslu S, Ozdemir H, Bulbul A, Comert S, Bolat F, Can E, et al. A comparison of different methods of temperature measurements in sick newborns. J Trop Pediatr 2011;57:418-23.  Back to cited text no. 10
Cultu O, Yildirim I, Ceyhan M, Korkmaz A, Yurdakök M, Karaağaoğlu E, et al. Comparing body temperature measurements by mothers and physicians using mercury-in-glass, digital mercury and infrared tympanic membrane thermometers in healthy newborn babies. Turk J Pediatr 2008;50:354-8.  Back to cited text no. 11
Zhen C, Xia Z, Long L, Pu Y. Accuracy of infrared ear thermometry in children: A meta-analysis and systematic review. Clin Pediatr (Phila) 2014;53:1158-65.  Back to cited text no. 12
Musumba CO, Griffiths KL, Ross A, Newton CR. Comparison of axillary, rectal and tympanic temperature measurements in children admitted with malaria. J Trop Pediatr 2005;51:242-4.  Back to cited text no. 13
Brown S. Temperature taking – Getting it right. Nurs Stand Spec Suppl 1990;4-5.  Back to cited text no. 14
Silverman BG, Daley WR, Rubin JD. The use of infrared ear thermometers in pediatric and family practice offices. Public Health Rep 1998;113:268-72.  Back to cited text no. 15
Schmitz T, Bair N, Falk M, Levine C. A comparison of five methods of temperature measurement in febrile intensive care patients. Am J Crit Care 1995;4:286-92.  Back to cited text no. 16
Abdulkadir MB, Johnson B. A comparative study of rectal tympanic and axillary thermometry in febrile children under 5 years of age in Nigeria. Paediatr Int Child Health 2013;33:165-9.  Back to cited text no. 17
Osinusi K, Njinyam MN. Comparison of body temperatures taken at different sites and the reliability of axillary temperature in screening for fever. Afr J Med Med Sci 1997;26:163-6.  Back to cited text no. 18
Charafeddine L, Tamim H, Hassouna H, Akel R, Nabulsi M. Axillary and rectal thermometry in the newborn: Do they agree? BMC Res Notes 2014;7:584.  Back to cited text no. 19
Friedrichs J, Staffileno BA, Fogg L, Jegier B, Hunter R, Portugal D, et al. Axillary temperatures in full-term newborn infants: Using evidence to guide safe and effective practice. Adv Neonatal Care 2013;13:361-8.  Back to cited text no. 20
Roll C, Wallot M, Hanssler L. Axillary versus rectal temperature measurement in premature and newborn infants. Z Geburtshilfe Neonatol 1998;202:207-11.  Back to cited text no. 21
Hissink Muller PC, van Berkel LH, de Beaufort AJ. Axillary and rectal temperature measurements poorly agree in newborn infants. Neonatology 2008;94:31-4.  Back to cited text no. 22
Shann F, Mackenzie A. Comparison of rectal, axillary, and forehead temperatures. Arch Pediatr Adolesc Med 1996;150:74-8.  Back to cited text no. 23


  [Table 1], [Table 2], [Table 3]


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