Thermal protection in neonates Hypothermia Significant problem in

Thermal protection in neonates

Hypothermia • Significant problem in neonates at birth and beyond • Contributes to significant morbidities • Mortality rate twice in hypothermic babies Teaching Aids: ENC NT- 2

Learning objectives • To describe how to keep a baby warm • To explain the factors which contribute to heat loss and how they can be prevented • To teach a mother how to keep her baby warm Teaching Aids: ENC NT- 3

Hypothermia: why are newborns prone? • Larger surface area per unit body weight • Decreased thermal insulation due to lack of subcutaneous fat (LBW infant) • Reduced amount of brown fat (LBW infant) Teaching Aids: ENC NT- 4

Mechanisms of heat loss Convection Evaporation Radiation Conduction Four ways a newborn may lose heat to the environment Teaching Aids: ENC NT- 5

Heat gain: 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 Teaching Aids: ENC NT- 6

Neutral thermal environment Range of environmental temperature in which an infant can maintain normal body temperature with minimal basal metabolic rate and least oxygen consumption Teaching Aids: ENC NT- 7

Definition & degrees of hypothermia Normal range Cold stress Moderate hypothermia Severe hypothermia Teaching Aids: ENC 37. 5 o 36. 5 o Cause for concern 36. 0 o Danger, warm baby 32. 0 o Outlook grave, skilled care urgently needed NT- 8

Temperature recording Axillary temperature recording for 3 minutes is recommended for routine monitoring Teaching Aids: ENC NT- 9

Diagnosis of hypothermia by human touch Feel by touch Trunk Warm Feel by touch Extremities Warm Interpretation Warm Cold stress Cold Hypothermia Teaching Aids: ENC Normal NT- 10

Causes of hypothermia 1. The room is too cold 6. The baby is placed on a cold surface or near cold wall or window The baby is exposed to cold draft 7. The baby has an infection 3. The newborn is wet 8. Baby has birth asphyxia and does not 4. The baby is uncovered , even for short time 2. have energy to keep warm 9. 5. Mother & baby are not together The baby is not feeding well Teaching Aids: ENC NT-11

Prevention of hypothermia at birth • Conduct delivery in a warm room (>250 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 in skin-to-skin contact with the mother • Initiate early breastfeeding • Postpone bathing Teaching Aids: ENC NT-12

Kangaroo mother care (KMC) • Assists in maintaining temperature • Facilitates breastfeeding • Increases duration of breastfeeding • Improves mother-baby bonding Teaching Aids: ENC NT-13

Kangaroo method Place baby in this position Teaching Aids: ENC Then cover with clothes NT-14

Bathing the baby n Small&/or LBW: - Till the cord falls or preferably till 2. 5 kg weight n Sick /admitted in nursery: - No bath n Term baby: - Postpone till next day Teaching Aids: ENC NT-15

Bathing the baby Warm room – warm water Dry quickly & thoroughly Dress warmly and wrap Give to mother to breast feed Teaching Aids: ENC NT-16

Cot-nursing in hospital (mother sick) • Cover adequately • Keep in thermoneutral environment • Monitor temperature 3 hourly during initial postnatal days Teaching Aids: ENC NT-17

Prevention of hypothermia during transport • Let temperature stabilize before transport • Document temperature and take appropriate action • Carry close to chest, if possible in kangaroo position • Cover adequately, avoid undressing Teaching Aids: ENC NT-18

Signs and symptoms of hypothermia Examine the baby`s temperature and activity Look for • Low temperature • Limp • Poor sucking or feeding • A weak cry • Slow or shallow respiration • Slow heart rate ( < 100/min) Teaching Aids: ENC NT-19

Signs and symptoms (cont. . ) • Due to peripheral vasoconstriction - acrocyanosis , cold extremities • Due to increased metabolism - hypoglycemia, metabolic acidosis • Due to increased pulmonary artery pressure - respiratory distress, tachypnea • Chronic signs - weight loss, failure to thrive Teaching Aids: ENC NT-20

Management: Cold stress • 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 Teaching Aids: ENC NT-21

Management: Moderate hypothermia • Skin to skin contact • Warm room/bed • Take measures to reduce heat loss • Provide extra heat - Room heater - Radiant warmer, incubator - Apply warm towels Teaching Aids: ENC NT-22

Using skin-to-skin contact to rewarm a cold baby • Make sure the room is warm • Place baby in skin-to-skin contact in a pre-warmed shirt opening at the front, a nappy, hat and socks • Cover the baby on the mother’s chest with her clothes AND an additional warmed blanket • Check temperature every 30 minutes • Keep the baby with the mother until the temperature is in the normal range Teaching Aids: ENC NT-23

Management: Severe hypothermia (<320 C ) • Provide extra heat preferably under radiant warmer or air heated incubator - rapidly warm till 340 C, then slow re-warming • Take measures to reduce heat loss • IV fluids: 60 -80 ml/kg of 10% Dextrose • Oxygen, if needed • Inj. vitamin K 1 mg in term & 0. 5 mg in preterm • If still hypothermic, consider antibiotics assuming sepsis Monitor HR, BP, Glucose (if available) Teaching Aids: ENC NT-24

Hyperthermia Temperature >37. 50 C Causes • The room is too hot • The baby has too many layers of covers / clothes • Baby is dehydrated because of not feeding properly • Baby has infection Teaching Aids: ENC NT-25

Hyperthermia How does hyperthermia affect the baby? • Dehydration or loss of body water • Convulsions • Shock • Coma and even death Teaching Aids: ENC NT-26

Hyperthermia Symptoms • Baby is Irritable • Has increased HR & RR • Has a flushed face • Skin is hot & dry • Late stages: apathetic, lethargic and then comatosed Teaching Aids: ENC NT-27

Management of hyperthermia • Place the baby in a normal temperature environment (25 to 280 C), away from any source of heat • Undress the baby partially or fully, if necessary • Give frequent breast feeds; give breast milk by cup if unable to suck • If temperature >390 C, sponge the baby with tap water; DO NOT use cold / ice water for sponge • Measure the temperature hourly till it becomes normal Teaching Aids: ENC NT-28

Scenario 1: Possible causes of hypothermia in delivery room You are asked by a senior staff to check if there is a problem in the delivery room. You discover several reasons why the delivery room may be too cold for babies and their mothers. Ø What is the problem ? List possible reasons Ø What action you will take ? Teaching Aids: ENC NT-29

Scenario 2: Postnatal ward You are in-charge of the postnatal ward in a district hospital. You have noticed that mothers are wearing jackets and think the ward is cold. You spend an afternoon assessing the postnatal ward. Ø Ø What could be the problem ? List what you have seen What are the simple doable actions ? Teaching Aids: ENC NT-30

Scenario 3: Hot weather The climate is very hot where you live. Ø What advice can you give to mothers and their families when they take their new baby home, to prevent their baby from becoming overheated? Teaching Aids: ENC NT-31

Conclusion • Prevent hypothermia, maintain “Warm chain” • Ensure closer monitoring and stricter preventive measures for LBW and other at risk neonates • Early detection and prompt simple interventions will prevent both hypo & hyperthermia Teaching Aids: ENC NT-32