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Hypothermia in newborn

hypothermia in newborn

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Hypothermia in newborn

  1. 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. 2 ■ Situations causing excessive heat loss ■ Poor ability to conserve ■ Poor metabolic heat production causes of hypothermia
  3. 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. 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. 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. 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. 7 heat loss skin-0.3c/min core-0.1c/min Thermal balance Conduction Radiation Convection Evaporation
  8. 8. 8 Response to cold • Muscular activity • Minimal shivering in term babies • Metabolic thermogenesis (non shivering thermogenesis)
  9. 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. 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. 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. 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. 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. 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. 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. 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. 17 Bathing the baby Warm room – warm water Dry quickly & thoroughly Dress warmly and wrap Give to mother to breast feed
  18. 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. 19
  20. 20. 20 The Kangaroo method
  21. 21. 21 The Kangaroo method Place baby in this position Then cover with clothes
  22. 22. 22
  23. 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
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  25. 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. 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. 27 Signs and symptoms (cont..) • Increased pulmonary artery pressure - respiratory distress, Cynosis tachypnea, pulmonary haemorrhage • Chronic signs - weight loss, failure to thrive
  28. 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. 29 Complications ■ Hypoglycaemia ■ Bleeding ,DIC ■ Acidosis ■ Hypotension ■ Shock ■ Respiratory distress ■ Pulmonary haemorrhage ■ Apnea ■ Cardiac arrest ■ Death
  30. 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. 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. 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. 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. 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. 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

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