Hypothermia

Significant problem in neonates at birth and even at 24 hrs of age and beyondMortality rate twice in hypothermic babies

Contributes to significant morbidity & mortality

Why are newborns prone to develop hypothermia ?

Larger surface area per unit body weightDecreased thermal insulation due to lack of subcutaneous fatReduced amount of brown fat (LBW infant )

Non shivering thermogenesis

Heat is produced by increasing metabolism, especially in brown adipose tissueBlood is warmed as it passes through the brown fat, and it in turn warms the body

Four ways a newborn may lose heat to the environment

Warm chain

Neutral thermal environment

Range of environmental temperature in which an infant can maintain normal body temperature with the least amount of basal metabolic rate oxygen consumption

Axillary temperature in the newborn infant ( oC )

Temperature recording

Axillary temperature recording for 3 minutes is recommended for routine monitoringDont record rectal temperatur in all babies as a standard protocolRecord rectal temperature in a sick hypothermic neonate

Normothermic baby *

Warm turnk Warm and pink soles

* Human touch

Prevention of hypothermia at birth

Delivery in warm roomDont bathe immediately after birthDry baby immediately with warm clean towelWrap baby in pre-warmed cloth, cover headKeep next to mather

Kangaroo care

Assists in maintaining temperatureFacilitates breastfeedingIncreasing duration of breastfeedingImproved mother baby bonding

The Kangaroo method

Bathing the baby

Warm room and warm waterBathe quickly and gentlyDry quickly and thoroughlyWrap in a warm, dry towelDress and wrap infantUse a capKeep close to mother

Cot nursing in hospital

Cover adequatelyKeep in thermoneutral environmentMonitor temperature 3 hourly during initial postnatal days

Signs and symptoms of hypothermia

Peripheral vasoconstriction- acrocyanosis, cold extremities- decreased perfusionCNS depression- lethargy, bradycardia, apnea, poor feedingIncreased metabolism- hypoglycemia, hypoxia, acidosis- lethargy, bradycardia, apnea,

Prevention of hypothermia (During Transport )

Let temperature stabilities always before transportDocument temperature and take remedial measuresCarry close to chestCover adequately, avoid undressingUse thermocol box with prewarm linen or plastic sheet or water filled mattress with thermostat

Management : Cold stress

Cover adequately remove cold clothes and replace with with warm clothes Warm room/bedTake measures to reduce heat loseKeep next to motherSkin-to-skin contactBreastfeeding

Signs and symptoms ( cont.)

Increased pulmonary artery presure- distress, tachypneaChronic signs- Weight loss, poor weight gain

Management : severe hypothermia

Provide extra heat* rapidly warm till 34 oC, then slowTake measures to reduce heat lossIV fluids 60-80 ml/kg 10% dextroseInj vit K, oxygenIf still hypothermic consider antibiotics

Management : Moderate hypothermia

Skin to skin contactWarm room/bedTake measures to reduce heat lossProvide extra heat* Apply warm heat* 200 W bulb* Heater, warmer, incubator

Hyperthermia > 37.5oC

Problem in summer monthsIrritable, increase HR, RRFlushed faceHot & dry skinApathetic, lethargic and paleStupor, coma, convulsions if temperature > 41oC

Conclusions

Maintain Warm ChainEarly detection by human touch and prompt remedial measures are key for reducing this preventable morbidity