hypothermia in newborn

1. 1
Hypothermia
• Significant problem in neonates at birth and
beyond ( 15%)
• Mortality rate twice in hypothermic babies
• Significant morbidity & mortality
• Preventable
• Lack of professional alertness of healthcare
providers

2. 2
■ Situations causing excessive heat loss
■ Poor ability to conserve
■ Poor metabolic heat production
causes of hypothermia

3. 3
■ Situations causing excessive heat loss
cold environment,
■ wet or naked baby,
■ cold linen,
■ during transport, and
■ procedures bath , blood sampling,
infusion
causes of hypothermia

4. 4
■ Poor ability to conserve— LBW, IUGR
■ Poor metabolic heat production-
deficiency of brown fat,
■ CNS damage,
■ hypoxia,
■ hypoglycaemia,
■ sepsis*
causes of hypothermia

5. 5
Why are newborns prone to
develop hypothermia
• Larger surface area per unit body weight
• Limited heat generating mechanisms(Non
shivering thermogenesis)
• vulnerability to getting exposed, being
dependent others

6. 6
factors in LBW/SFD
• Larger surface area than term babies
• Poor insulation (lower subcutaneous fat)
• More permeable skin
• Decreased brown fat
• Poor physiological response to cold
• Early exhaustion of metabolic stores like
glucose

7. 7
heat loss skin-0.3c/min
core-0.1c/min
Thermal balance
Conduction
Radiation
Convection
Evaporation

8. 8
Response to cold
• Muscular activity
• Minimal shivering in term babies
• Metabolic thermogenesis (non shivering
thermogenesis)

9. 9
Non-shivering thermogenesis
• Heat is produced by increasing the metabolism
especially in brown adipose tissue*
• Blood is warmed as it passes through the brown
fat and it in turn warms the body
• Effective thermogenesis require—adequate
brown fat, glucose ,oxygen and intact CNS
pathways

10. 10
Neutral thermal environment
Range of environmental temperature in
which an infant can maintain normal
body temperature with least amount
of BMR and oxygen consumption
normal temperature 36.5-37.3
temperature change not more than 0.3 for skin and
Fall of 2 *C==25% heat generation

11. 11
Temperature recording
• Axillary temperature recording for 3
minutes is recommended for routine
monitoring
• rectal temperature(2min) is unnecessary in
most situations
• human touch( back of the fingers)

12. 12
Diagnosis of hypothermia by
human touch
Feel by touch
Trunk
Feel by touch
Extremities
Interpretation
Warm Warm Normal
Warm Cold Cold stress
Cold Cold Hypothermia

13. 13
Normal range
Cold stress
Moderate hypothermia
Severe hypothermia Outlook grave, skilled
care urgently needed
Danger, warm baby
Cause for concern
37.5o
36.5o
36.0o
32.0o
Axillary temperature in the
newborn (0C)

14. 14
1. Warm delivery room
(>250 C)
2. Warm resuscitation
3. Immediate drying
4. Skin-to-skin contact
5. Breastfeeding
6. Bathing postponed
7. Appropriate clothing
8. Mother & baby
together
9. Professional alert
10. Warm transportation
Prevention of hypothermia: Warm chain

15. 15
Prevention of hypothermia at birth
• Conduct delivery in a warm room( 27.C)
• Dry baby including head immediately with
warm clean towel
• Wrap baby in pre-warmed linen; cover the
head and the limbs
• Place the baby skin to skin on the mother
• Postpone bathing

16. 16
Bathing the baby
Timing of bath
■ Small&/or LBW:
Till the cord falls or
preferably till 2.5 kg
weight
■ Sick /admitted in nursery:
No bath
■ Term baby:
Postpone till next day
Procedure
■ Warm room and warm
water
■ Bathe quickly and gently
■ Dry quickly and
thoroughly
■ Wrap in a warm, dry
towel
■ Dress and wrap infant
■ Use a cap
■ Keep close to mother

17. 17
Bathing the baby
Warm room – warm water Dry quickly & thoroughly
Dress warmly and wrap Give to mother to breast feed

18. 18
Kangaroo Mother care
• Assists in maintaining temperature
• reduces risk of apnea
• reduced risk of infections
• babies cry less and sleeps better(better
neurobehavioral development)
• Facilitates breastfeeding
• Increases duration of breastfeeding
• Improves mother-baby bonding
• better weight gain and early discharge

19. 19

20. 20
The Kangaroo method

21. 21
The Kangaroo method
Place baby in this position Then cover with clothes

22. 22

23. 23
Cot-nursing in hospital
(mother sick)
• Cover adequately in layering*
• adequate feeding( EBF/assisted)
• Keep in thermoneutral environment
• Monitor temperature 3 hourly during initial
postnatal days

24. 24

25. 25
Prevention of hypothermia
(during transport)
• Let temperature stabilize before transport
• Document temperature and take remedial measures
• Carry close to chest,
• if possible in kangaroo position
• Cover adequately, avoid undressing
• Use thermocol box with pre-warmed linen or plastic
sheet or water filled mattress with thermostat

26. 26
Signs and symptoms of
hypothermia
• Peripheral vasoconstriction
- acrocyanosis, cold extremities, mottling
- decreased peripheral perfusion
• CNS depression
- lethargy, poor feeding
bradycardia, seizures
apnea

27. 27
Signs and symptoms (cont..)
• Increased pulmonary artery pressure
- respiratory distress, Cynosis
tachypnea, pulmonary haemorrhage
• Chronic signs
- weight loss, failure to thrive

28. 28
Hypothermia
catecholamines release reduced surfactant production
uncoupling of
beta oxidation
release of FFE
Displaces bilirubin
from albumin
Hyperbillirubinemia
increased BMR
Hypoglycaemia increased o2 requirement
pulmonary and peripheral vasoconstriction
Anaerobic metabolism,
Glycolysis,Hypoxemia,
Metabolic acidosis
CNS and cardiac depression

29. 29
Complications
■ Hypoglycaemia
■ Bleeding ,DIC
■ Acidosis
■ Hypotension
■ Shock
■ Respiratory distress
■ Pulmonary haemorrhage
■ Apnea
■ Cardiac arrest
■ Death

30. 30
Management: Cold stress
(<36.5)
• Cover adequately - remove cold clothes and replace with
warm clothes
• Warm room/bed
• Take measures to reduce heat loss
• Ensure skin-to-skin contact with mother; if not possible,
keep next to mother after fully covering the baby
• Breast feeding*
Monitor axillary temperature every ½ hour till it reaches 36.50 C, then hourly for
next 4 hours, 2 hourly for 12 hours thereafter and 3 hourly as a routine

31. 31
Management: Moderate
hypothermia(32.0°C to 35.9°C )
• Skin to skin contact
• Feeding
• Warm room/ warmer
• Take measures to reduce heat loss
• Provide extra heat
- 200 W bulb
- Heater, warmer, incubator
- Apply warm towels

32. 32
Management: Severe
hypothermia (<320C )
• Provide extra heat preferably under radiant warmer or
air heated incubator
- rapidly warm till 340C, then slow re-warming
• Take measures to reduce heat loss
• Manage T A B C*
• IV fluids: 60-80 ml/kg of 10% Dextrose
• Oxygen
• Inj.vitamin K 1mg in term & 0.5 mg in preterm
• If still hypothermic, consider antibiotics assuming sepsis
Monitor HR, BP, Glucose (if available)

33. 33
Hyperthermia > 37.50C
• Problem in summer months
• May indicate infection in term babies
• Irritable, increased HR & RR
• Flushed face, hot & dry skin
• Apathetic, lethargic and pale
• Stupor, coma, convulsions if temperature > 410C

34. 34
• Place the baby in a normal temperature
environment (25 to 280C), away from any source
of heat
• Undress the baby partially or fully, if necessary
• Give frequent breast feeds
• If temperature > 390C, sponge the baby with tap
water; don’t use cold / ice water for sponge
• Measure the temperature hourly till it becomes
normal
Management of hyperthermia

35. 35
Conclusion
• Prevent hypothermia, maintain “Warm chain”
• Ensure closer monitoring and stricter preventive
measures for LBW and other at risk neonates
• Early detection and prompt remedial measures
are key for reducing this preventable morbidity