MANAGEMENT OF HYPOTHERMIA 09.06.2022.pptx

hypothermia management in children

1. MANAGEMENT OF HYPOTHERMIA PRESENTED BY: VANITHA.N RAMAIAH INSTITUTE OF NURSING EDUCATION AND RESARCH.

2. Introduction Temperature management remains a significant component of hospital care for all neonatal and paediatric patients. Body temperatures outside normal ranges may be indicative of underlying disease processes or clinical deterioration, and should be identified within a timely manner. Maintaining a stable body temperature within normal ranges assists in optimising metabolic processes and bodily functions. Therefore, minimising environmental factors within the hospital setting which may result in unnecessary body temperature fluctuations is further important. 

3. Hypothermia : An abnormally low body temperature, where the body temperature drops below 35°C (95°F) . Hypothermia can be caused by environmental factors, metabolic complications, disease processes, or can be medically induced.  More due to lack of knowledge than to lack of equipment . • No single environmental temperature that is appropriate for all sizes, gestational ages and conditions of newborn babies • Early marker of thermal stress NORMAL BODY TEMPERATURE: 36.5 TO 37.4 C

4. At Risk Patient Groups The following patient populations are at an increased risk of being unable to maintain normal body temperature:  Neonates and young infants  Peri and post-operative patients Burns patients Trauma patients  Neurologically compromised patients 

5. Importance of temperature regulation in newborns Warmth is one of the basic needs of a newborn baby; it is critical to the baby’s survival and wellbeing. Unlike adults newborn babies are often not able to keep themselves warm especially if the environmental temperature is low. This results in hypothermia .  

6. HANDICAPS IN NEWBORN • Larger surface area to body mass ratio • Less of subcutaneous fat • Increased insensible losses : Thin skin • Lack of behavioral mechanisms • Predisposition for sepsis, hypoglycemia • Limited non shivering thermogenesis • Narrow thermal neutral zone

7. NEWBORN LOSES HEAT BY: Evaporation: soon after birth due to evaporation of amniotic fluid from skin surfaces. Conduction: by coming in contact with cold objects e.g. cloth, tray etc. Convection: by aircurrnets in which cold air from open windows replaces warm air around baby Radiation: to colder solid objects in vinicity eg : walls.

8. TEMPERATURE RECORDING Accurate temperature recording is needed if a baby is: Preterm/low birth weight or sick Admittd to hospital, regardless of reason Suspected of being hypothermic Being re – warmed during the management of hypothermic Being cooled down during the management of hyperthermia. Axillary temperature is needed, one of the safest method recording for 3 minutes is recommended for routine monitoring

9. CATEGORY TEMPERTURE RANGE FEEL BY TOUCH CLINICAL FEATURES Normal 36.5 TO 37.4 C Warm trunk, warm extremities Normal baby Mild hypothermia(cold stress) 36 to 36.4 C Warm trunk, cold extremities Extremities bluish and cold, poor weight gain if chronic cold stress Moderate hypothermia 32 to 35.9 C Cold trunk, cold extremities Poor sucking, lethargy, weal cry, fast breathing Severe hypothermia Less then 32 C Cold trunk, cold extremities Lethargic, poor perfusion, fast or slow breathing, slow heart rate, hardening of skin with redness and edema, bleeding, low blood sugar ASSESSMENT, CLINICALFEATURES AND CLASSIFICATION OF HYPOTHERMIA

10. MANAGEMENT OF 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 until it reaches 36.5 C, then hourly for next 4 hours, 2 hourly for 12 hours thereafter.

11. MANAGEMENT OF 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

12. MANAGEMENT OF SEVERE HYPOTHERMIA • Provide extra heat preferably under radiant warmer or air heated incubator. • rapidly warm till 34 degrees C, then slow re‐warming • Take measures to reduce heat loss. • IV fluids: 60 ‐ 80 ml/kg of 10% Dextrose. • Oxygen. • 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).

13. MEASURES IN DELIVERY ROOM Thermoregulation • Draft free area • Pre‐warmed linen • Heat source • Room temp : 28‐30 degrees C • Remove wet linen • Dry thoroughly & Wrap • Promote skin to skin contact

14. THERMAL CARE (PNC WARD) • Ensure warmth • Cover the head • Promote rooming in • Avoid baby bath in hospital • Do not remove vernix caseosa • Early & Exclusive breast feeding

15. KANGAROO CARE • Assists in maintaining temperature • Facilitates breastfeeding • Increases duration of breastfeeding • Improves mother‐baby bonding

16. THANK YOU