Hypothermia in newborns can occur due to a variety of factors that increase heat loss or impair thermoregulation. The document defines hypothermia and describes the causes, risk factors, methods of heat loss, grading, clinical presentations, and management approaches for mild, moderate, and severe hypothermia in newborns. Management involves rewarming the baby through skin-to-skin contact or radiant warmer depending on severity, monitoring temperature increases, treating other issues like low blood sugar, and encouraging feeding once stabilized.
2. Definition
• Auxiliary temperature less then 36.5 degree C (96.8 degree F) is called
hypothermia
• Where a normal auxiliary temperature is between 36.5-37.5 degree
centigrade(97.8-99 degree F)
3. Causes
• Larger surface area per unit body weight
• Larger head size in relation to surface area
• Low subcutaneous and brown fat
• Thin and immature skin
• Low energy storage
• Poor thermoregulation
4. Others risk factors
• Cool room
• Delay and inadequate drying
• Improper wrapping
• Not feeding well
• Cold surface area
5.
6. Ways of heat loss in newborn
• Conduction : when body surface area come in contact with cold
objects like cloths table or weighing machine body loss heat through
conduction
• Convection : when the baby is expose to cold air
• Evaporation : soon after birth amniotic fluid evaporate from skin
causes heat loss
• Radiation: when the body is near to cold objects such as wall
7. Method of grading hypothermia
Human touch with back of the hand
• Normal: warm trunk (over abdomen ) and warm pink soles
• Cold stress: warm trunk but cold feet
• Hypothermia: cold feet and trunk
8. Monitoring of auxiliary temperature
Normal temperature 36.5 – 37.5 Degree centigrade
Mild hypothermia (cold stress) Less then 36.5-36 degree centigrade
Moderate hypothermia Less then 36-32 degree centigrade
Severe hypothermia Less 32 degree centigrade
9. Clinical presentation
Mild hypothermia Moderate hypothermia Severe hypothermia
Restlessness Difficulty breathing Breathing difficulty
Excessive cry bradycardia Poor or no feeding , hypoglycemia
Acrocyanosis Poor or no feeding Lethargy , poor reflexes
Cold extremities Lethargy, poor reflexes Hardened skin
Poor feeding Cold to touch Slow , shallow and irregular
respiration
Delay capillary refill Cold to touch
oliguria Abdominal distension , Apnea
10. Management of hypothermia
Mild hypothermia:
• Quick rewarming of the baby by removing wet clothes
• Cover baby properly including head
• Encourage and help kangaroo mother care
• Maintain warm room temperature
• Breast feeding and close monitor of temperature in every 15-30
minutes
11. Moderate hypothermia
• Remove cold or wet clothing, if present.
• If the mother is present, have her rewarm the baby using skin-to-skin
contact, if the baby does not have other problems.
• Dress the baby in warm clothes and a hat, and cover with a warm blanket;
• Warm the baby using a radiant warmer. Use another method of rewarming,
if necessary.
• Encourage the mother to breastfeed more frequently. If the baby cannot be
breastfed, give expressed breast milk using an alternative feeding method
12. Conti….
• Measure blood glucose . If the blood glucose is less than 45 mg/dl ,
treat for low blood glucose
• If the baby’s respiratory rate is more than 60 breaths per minute or the
baby has chest indrawing or grunting on expiration, treat for breathing
difficulty
• Measure the baby’s temperature every hour for three hours:
• If the baby’s temperature is increasing at least 0.5 °C per hour over the
last three hours, rewarming is successful; continue measuring the
baby’s temperature every two hours;
13. Conti….
• If the baby’s temperature does not rise or is rising more slowly than
0.5 °C per hour, look for signs of sepsis (e.g. poor feeding, vomiting,
breathing difficulty)
• Once the baby’s temperature is normal, measure the baby’s
temperature every three hours for 12 hours;
• If the baby’s temperature remains within the normal range, discontinue
measurements.
• If the baby is feeding well and there are no other problems requiring
hospitalization, discharge the baby . Advise the mother how to keep
the baby warm at home.
14. Severe hypothermia
• Warm the baby immediately using a prewarmed radiant warmer. Use
another method of rewarming, if necessary.
• Remove cold or wet clothing, if present. Dress the baby in warm
clothes and a cap, and cover with a warm blanket.
• Treat for sepsis, and keep the tubing of the IV line under the radiant
warmer to warm the fluid.
• Measure blood glucose . If the blood glucose is less than 45 mg/dl,
treat for low blood glucose .
15. Conti….
Assess the baby:
• Look for emergency signs (i.e. respiratory rate less than 20 breaths per
minute, gasping, not breathing, or shock) every hour; - Measure the
baby’s temperature every hour:
• If the baby’s temperature is increasing at least 0.5 °C per hour over the
last three hours, rewarming is successful; continue measuring the
baby’s temperature every two hours;
• If the baby’s temperature does not rise or is rising more slowly than
0.5 °C per hour, ensure that the temperature of the warming device is
set correctly.
16. Conti….
• If the baby’s respiratory rate is more than 60 breaths per minute or the
baby has chest indrawing or grunting on expiration, treat for breathing
difficulty .
• Assess readiness to feed every four hours until the baby’s temperature
is within the normal range.
• If the baby shows signs of readiness to suckle, allow the baby to begin
breastfeeding
• If the baby cannot be breastfed, give expressed breast milk using an
alternative feeding method.