Hypothermia

 Hypothermia

New born baby more prone to develop hypothermia because of large surface area per unit of body weight.

Low birth weight baby develop hypothermia because of decreased thermal insulation due to less subcutaneous fat and reduced amount of brown fat (site of heat production).

Normal axillary temperature; 36.5-37.5 degree Celsius.

Hypothermia classification

Cold stress; 36.0 - 36.4 degree Celsius 

Moderate hypothermia; 32.0- 35.9 degree Celsius

Severe hypothermia; <32 degree Celsius

Thermal Regulation

(Mechanism of heat loss)

1. Evaporation

2. Conduction

3. Convection

4. Radiation

1. Evaporation

Heat loss due to evaporation.

Such as; 

after birth amniotic fluid from skin surface.

Wet baby

2. Conduction

Heat loss by coming contact with cold object.

Such as;

Cloths, surface, tray

3. Convection

Heat loss by air current.

Such as;

Cold air from open window, fans (replaces warm air around baby).

4. Radiation

Heat loss by radiation.

Such as;

Heat loss due to colder solid object; walls iron almirah, 

Temperature Recording

1. Axillary temperature

2. Rectal temperature

Kept at least 2 minutes.

For hypothermic sick neonates.

Interm baby; depth 3cm

Term baby; depth 2cm

3. Skin temperature

Probe of thermistor is attached to skin over upper abdomen.

Thermistor senses skin temperature and display it on panel.

4. Tympanic temperature 

Clinical manifestations 

Baby's Warm and pink feet indicate thermal comfort.

When feet are cold and trunk is warm indicate baby is in cold stress.

1. Cool extremities

2. Bluish discoloration of skin

3. Hypoglycemia

4. Hypoxia

5. Decrease peripheral perfusion

6. Poor feeding

7. Metabolic acidosis

8. Lethargy

9. Apnea

10. Bradycardia

11. Respiratory distress

12. Tachypnea

13. Weight loss

14. Poor weight gain

Management

1. Reward the infant quickly

Method to manage cold stress;

1. Skin to skin contact

2. Clothed the baby, head and extremities convered 

3. Warm room

4. Incubator or radiant warmer

2. Incase of moderate hypothermia

Skin to skin contact, continuous rewarming, incubator or radiant warming 

3. Incase of severe hypothermia

Continuous rewarming, incubator or radiant warmer 

Monitor baby temperature, pulse rate , Respiration rate and blood pressure.

a. Preventive measure taken to reduce heat loss

b. 10% dextrose started intravenously rate of 60-80ml/kg/day.

c. Administer vitamin K 1mg to term baby.

Administer vitamin K 0.5mg to preterm baby.

d. If required, provide oxygen.

Prevention of Hypothermia

1. Warm delivery room (>25 degree Celsius).

Immediately drying

Warm resuscitation; placing radiant warmer source)

Make sure baby stay warm, cover baby head with cap.

2. Kangaroo method

Skin to skin contact between baby and mother

Improve mother infant bonding

Increase duration of brestfeeding

3. Bathing the baby

Bathing should be avoided 24 hrs in term baby.

Before giving bath, baby temperature should be normal.

In preperm baby/ low birth weight baby postpond bath till umbilical cord falls off or baby weight reaches 2.5 kg.

4. Cot- nursing in hospital; if mother is sick

5. Temperature maintenance during transport

Warm transportation (incubator)

Clothed the baby; cover head with cap, legs and hand).

Carry the baby close to chest of mother.

Record temperature before transport