Hypothermia in newborn

hypothermia in newborn

1. 1
Hypothermia
•Significantprobleminneonatesatbirthand
beyond(15%)
•Mortalityratetwiceinhypothermicbabies
•Significantmorbidity&mortality
•Preventable
•Lackofprofessionalalertnessofhealthcare
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
•Largersurfaceareaperunitbodyweight
•Limitedheatgeneratingmechanisms(Non
shiveringthermogenesis)
•vulnerabilitytogettingexposed,being
dependentothers

6. 6
factors in LBW/SFD
•Largersurfaceareathantermbabies
•Poorinsulation(lowersubcutaneousfat)
•Morepermeableskin
•Decreasedbrownfat
•Poorphysiologicalresponsetocold
•Earlyexhaustionofmetabolicstoreslike
glucose

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

8. 8
Response to cold
•Muscularactivity
•Minimalshiveringintermbabies
•Metabolicthermogenesis(nonshivering
thermogenesis)

9. 9
Non-shivering thermogenesis
•Heatisproducedbyincreasingthemetabolism
especiallyinbrownadiposetissue*
•Bloodiswarmedasitpassesthroughthebrown
fatanditinturnwarmsthebody
•Effectivethermogenesisrequire—adequate
brownfat,glucose,oxygenandintactCNS
pathways

10. 10
Neutral thermal environment
Rangeofenvironmentaltemperaturein
whichaninfantcanmaintainnormal
bodytemperaturewithleastamount
ofBMRandoxygenconsumption
normal temperature 36.5-37.3
temperature change not more than 0.3 for skin and o.2/hr for core
Fall of 2 *C==25% heat generation

11. 11
Temperature recording
•Axillarytemperaturerecordingfor3
minutesisrecommendedforroutine
monitoring
•rectaltemperature(2min)isunnecessaryin
mostsituations
•humantouch(backofthefingers)

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
37.5
o
36.5
o
36.0
o
32.0
o
Axillary temperature in the
newborn (
0C)

14. 14
1.Warm delivery room
(>25
0
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
•Conductdeliveryinawarmroom(27.C)
•Drybabyincludingheadimmediatelywith
warmcleantowel
•Wrapbabyinpre-warmedlinen;coverthe
headandthelimbs
•Placethebabyskintoskinonthemother
•Postponebathing

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
•Assistsinmaintainingtemperature
•reducesriskofapnea
•reducedriskofinfections
•babiescrylessandsleepsbetter(better
neurobehavioraldevelopment)
•Facilitatesbreastfeeding
•Increasesdurationofbreastfeeding
•Improvesmother-babybonding
•betterweightgainandearlydischarge

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)
•Coveradequatelyinlayering*
•adequatefeeding(EBF/assisted)
•Keepinthermoneutralenvironment
•Monitortemperature3hourlyduringinitial
postnataldays

24. 24

25. 25
Prevention of hypothermia
(during transport)
•Lettemperaturestabilizebeforetransport
•Documenttemperatureandtakeremedialmeasures
•Carryclosetochest,
•ifpossibleinkangarooposition
•Coveradequately,avoidundressing
•Usethermocolboxwithpre-warmedlinenorplastic
sheetorwaterfilledmattresswiththermostat

26. 26
Signs and symptoms of
hypothermia
•Peripheralvasoconstriction
-acrocyanosis,coldextremities,mottling
-decreasedperipheralperfusion
•CNSdepression
-lethargy,poorfeeding
bradycardia,seizures
apnea

27. 27
Signs and symptoms (cont..)
•Increasedpulmonaryarterypressure
-respiratorydistress,Cynosis
tachypnea,pulmonaryhaemorrhage
•Chronicsigns
-weightloss,failuretothrive

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)
•Coveradequately-removecoldclothesandreplacewith
warmclothes
•Warmroom/bed
•Takemeasurestoreduceheatloss
•Ensureskin-to-skincontactwithmother;ifnotpossible,
keepnexttomotherafterfullycoveringthebaby
•Breastfeeding*
Monitoraxillarytemperatureevery½hourtillitreaches36.5
0
C,thenhourlyfor
next4hours,2hourlyfor12hoursthereafterand3hourlyasaroutine

31. 31
Management: Moderate
hypothermia(32.0°C to 35.9°C )
•Skintoskincontact
•Feeding
•Warmroom/warmer
•Takemeasurestoreduceheatloss
•Provideextraheat
-200Wbulb
-Heater,warmer,incubator
-Applywarmtowels

32. 32
Management: Severe
hypothermia (<32
0
C)
•Provideextraheatpreferablyunderradiantwarmeror
airheatedincubator
-rapidlywarmtill34
0
C,thenslowre-warming
•Takemeasurestoreduceheatloss
•ManageTABC*
•IVfluids:60-80ml/kgof10%Dextrose
•Oxygen
•Inj.vitaminK1mginterm&0.5mginpreterm
•Ifstillhypothermic,considerantibioticsassumingsepsis
MonitorHR,BP,Glucose(ifavailable)

33. 33
Hyperthermia > 37.5
0
C
•Probleminsummermonths
•Mayindicateinfectionintermbabies
•Irritable,increasedHR&RR
•Flushedface,hot&dryskin
•Apathetic,lethargicandpale
•Stupor,coma,convulsionsiftemperature>41
0
C

34. 34
•Place the baby in a normal temperature
environment (25 to 28
0
C), away from any source
of heat
•Undress the baby partially or fully, if necessary
•Give frequent breast feeds
•If temperature > 39
0
C, 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
•Preventhypothermia,maintain“Warmchain”
•Ensure closer monitoring and stricter preventive
measures for LBW and other at risk neonates
•Earlydetectionandpromptremedialmeasures
arekeyforreducingthispreventablemorbidity