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
• High respiratory rate
• 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.
• If the mother is not present or skin-to-skin contact cannot be used.
• 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.
