Basic thermal care for Newborn baby in Delivery room/ transport and Neonatal intensive care Unit

1. THERMAL CARE
DR.PRITESH B PATEL
(MBBS, MD PEDIA, FIAP (NEONATOLOGY), PGPN)
NEOCARE NICU AND CHILDREN HSPITAL
NAVSARI

2. • HOMEOTHERMIC
• INCIDENCE -18.4 %
• THERMAL PROTECTION –CONTINUES
MEASURE
AXILLARY TEMPERATURE
NORMAL 36.5-37.5 C
MILD HYPOTHERMIA/ COLD
STRESS
36- 36.4 C
MODERATE HYPOTHERMIA 32- 35.9 C
SEVERE HYPOTHERMIA < 32 C
HYPERTHERMIA > 37 C

3. THERMO NEUTRAL ENVIRONMENT
• NARROW RANGE
• MINIMUM BMR/ OXYGEN UTILISATION/ THRIEVE
WELL
THERMO NEUTRAL ZONE
• THERMO REGULATORY ENVIRONMENT
WEIGHT RECOMMENDED AMBIENT TEMPERATURE
35 C 34 C 33 C 32 C
< 1500 G 1-10 D 11 D – 3 W 3 W- 5 W > 5 W
1500- 1999G 1-10 D 11 D – 4 W > 4 W
2000- 2499 G 1-2 D 3 D -3 W > 3 W
> 2500 G 1-2 D > 3 D

4. FACTORS INTERFERING WITH
THERMOREGULATION
• CORE BODY TEMPERATURES CORRELATES
WITH MOTHER(1 C ABOVE MOTHER)
• 4 BASIC MECHANISMS
– EVAPORATION (HUMIDITY)
– CONDUCTION (SURFACE)
– CONVECTION (SURROUNDING AIR)
– RADIATION (NEARBY OBJECT)
INSUFFICIENT WARMED ROOM, BABY UNCOVERD, DELAY DRYING, IMMEDIATE
BATHING, DELAY BREAST FEED INCREASE THE RISK OF HEAT LOSS.

6. • CORE BODY TEMPERATURE MAINTAINED
THROUGH
– VASOCONSTRICTION
– SHIVERING (ADULT)
– NON-SHIVERING THERMOGENESIS
– CHEMICAL THERMOGENESIS (BROWN FAT){TERM NEWBORN}

7. TEMPERATURE RECORDING
• SCHEDULE OF TAKING TEMPERATURE
- IMMEDIATE
- ARRIVAL IN NICU/ POST NATAL WARD
• SICK BABIES EVERY 1-2 HR
• 1.5TO 2.5 KG EVERY 12 HR
• < 1.5 KG EVERY 6 HR

8. METHODS
• TOUCH – abdominal skin and hand and feet
with back of hand
(abdominal temp representative of core temp)
Feet and hand warm -Thermal comfort
Feet and hand cold but abdo warm - Cold stress
Feet , hand , abdomen cold - Hypothermia

9. • THERMOMETERS –
– record upto 30 c
• THERMISTER PROBES –skin probe
– Radiant warmer , incubator
– Upper abdomen

10. SITE OF TEMPERATURE RECORDING
BODY SITE TYPE OF
THERMOMETER
NORMAL
RANGE
ADV DISADV
AXILLA DIGITAL 35.6-37.3 SAFE AND EASY NOT RELIABLE IN
HYPOTHERMIC
RECTAL THERMISTER
PROBE
36.5-37.5 CONTINUES
USED IN
ASPHYXIATING
PERFORATION
NEC/INFECTION
SKIN THERMISTER
PROBE
35.5-36.6 FASTER OVERHEAT
ESOPHAGEAL INNERSENSE
TEMP SENSOR
36.5-37.5 INTRA
OPERATIVE
EXPENSIVE
EAR INFRARED 35.5-37.3 RAPID NOT RELIABLE

11. CLINICAL MANIFESTATIONS
• BODY AND EXTREMETIES COOL
• ACROCYNOSIS
• SKIN MOTTLING
• BRADYCARDIA
• APNEA/SHALLOW BREATHING
• LETHARGIC
• HYPOTONIA
• DEPRESSION

12. • EARLYSIGNS
– BECAUSE OF PERIPHERAL VASOCONSTRICTION
– PALLOR
– ACROCYNOSIS
– COOL EXTREMITIES
– DECREASED PERIPHERAL PERFUSION
– IRRITABILITY

13. • LATE SIGNS
• CNS DEPRESSION –
LETHARGY / BRADYCARDIA/ APNEA/ POOR
FEEDING HYPOTONIA / WEAK SUCK/ CRY /
EMESIS
• INCREASED PULMONARY PRESSURE –
RESPIRATORY DISTRESS
• ABDOMINAL SIGNS –
INCREASED GASTRIC RESIDUAL, DISTENTION EMESIS

14. CONSEQUENCES OF HYPOTHERMIA
• HYPOGLYCEMIA
• HYPOXIA
• METABOLIC ACIDOSIS
• PULMONARY VASOCONSTRICTION
• SURFACE PRODUCTION DECREASED
• POOR WEIGHT GAIN
• ARF
• DIC
• DEATH

15. MANAGEMENT IN DELIVERY ROOM
SIURCE OF HEAT LOSS PREVENTIVE MEASURE
CONDUCTION WARM SURFACE
WARM SHEETS/ BLANKETS
HEAD COVER
WARM SOLUTION
CONVECTION ROOM TEMP 25-28C
INCUBATOR
NEWBORN COVERED
RADIATION RADIENT WARMER
WRAP NEONATE
WARM ROOM
EVAPORATION HEATED /HUMIDIFIED GAS
PLASTIC WRAP(<28 W)
HUMIDIFICATION INSIDE INCUBATOR

16. THE CONCEPT OF WARM CHAIN
WHO GUIDELINE – SET OF 10 INTERLINK STEP

17. PROPER WIPING AND WRAPING
• IMMIDIATE- WIPED , DRIED, COVERED
(EVAPORATION PREVENT)
• HEAD CAPS (WOOLLEN)
• TOPICAL AGENTSAND OILS MASSAGE
– PARAFFIN, PETROLIUM, MINERAL OIL AND LANOLIN
OR CORN, SUNFLOWER, SESAME OR SAFFLOWER
OIL, COCONUT OIL
– REDUCED TRANSEPIDERMAL WATER LOSS AND
HEAT LOSS

18. SKIN TO SKIN CARE
• PROMISING RESULT
• AS EFFECTIVE AS INCUBATOR
• KMC- CONTINUES AND PROLONG
– IMPROVED THERMOREGULATION
– MATERNAL-INFANT BONDING
– PHYSIOLOGICAL STABILITY
– IMPROVED BF AND GROWTH
– REDUCED INFECTION
– EARLY DISCHARGED
– UNIVERSAL STRETAGY IN U.P.

19. POSTPONE BATHING AND WEIGHING
• POSTPONE IN ALL
• IDEAL GIVEN AT HOME AFTER DICHARGED
• FOR < 2.0 KG –WAIT TILL 2.0 KG
• WEIGHING AFTER 1 HOUR

20. CLOTHING AND BEDDING IN
• 1-2 LAYER CLOTHS
• CAP
• SOCKS
• MITTEN

21. BREAST FEEDING
• HEAT EXCHANGE BETWEEN NEWBORN AND
MOTHER
• PREVENT HYPOTHERMIA
• PREVENTS BACTERIAL INFECTION
• PROVISIONOF CALORIES FROM FAT
• PROCESS OF SUCKLING
• STIMULATES BMR
• THERMOREGULATION

22. WARM TRANSPORTATION
• HOME, ANOTHER HOSPITAL, WARD
• TRANSPORTED IN SKIN TO SKIN POSTURE
(STABLE)
• INCUBATOR (VLBW/ SICK)
• TEMPERATURE – BEFORE/AFTER
• IN- UTERO TRANSFER

23. TRAINING AND AWARENESS
• ALL HEALTH CARE PERSONNEL

24. THERMAL MANAGEMENT IN
PRETERM
• POLYETHYLENE POLYURETHANE OCCLUSIVE
BAGS AND WRAPS (<32WEEKS)
• INCUBATORS
• RADIENT WARMERS
• HYBRID INCUBATORS
• KANGAROO MOTHER CARE
• HEATED WATER FILLE MATRESS
• PHASE CHANGING MATERIAL DEVICES

25. MANAGEMENT
• COLD STRESS
– REMOVE COLD/WET CLOTHS, COVER THE BABY
– WARM ENVIRONMENT
– SKIN TO SKIN CONTACT
– BREASST FEED
– MONITOR AXILLARY TEMP EVERY ½ TO 1 HR TILL
36.5 C
HOURLY FOR 4 HR
2 HOURLY FOR 12 HR

26. • MODERATE HYPOTHERMIA
– EXTRA HEAT -
HEATER/WARMER/INCUBATOR/WARM TOWEL
– SKIN TO SKIN CONTACT
– WARM ROOM/BED

27. • SEVERE HYPOTHERMIA
– HOSPITALISATION
– RAPID REWARMING UNTILL 34 C THEN SLOW
REWARMING (36.5 C)
– IVF AT 60-80 ML/KG OF 10%
– MONITOR RBS
– VIT K

28. HYPERTHERMIA
• > 37.5 C
• CAUSES
– HOT ENVIRONMENT /CLOTHS/DEHYDRATION/SEPSIS
• SYMPTOMS
• EARLY – IRRITABLE/TACHYCARDIA/TACHYPNEA/FLUSHED FACE/DRY SKIN
• LATE – APATHY , LETHARGY COMA
• SEVERE – SHOCK, CONVULSIONS EVEN DEATH
• MANAGEMENT
– NORMAL ENVIRONMENT (25-28 C), UNDRESS, BREAST FEED
– > 39 C – SONGED
– HOURLY TEMP MONITOR