1. Dr Prakash.I

2. Important factor influencing newborn Health.
 It remains a significant challenge, especially in
the perinatal care of preterm infants.
 Clinical experience suggests that hypothermia
remains
 An ongoing problem, especially among ELBW
infants, even for those born in Level III perinatal
centers.
 Preterm delivery less than 28 weeks or less than
1000 g occurs in 1–2% of all deliveries, but
accounts for the large majority of neonatal
morbidity and mortality.
 Therefore, this topic deserves special attention.


3.  Newborn
infant
has
immature
thermo-
regulation.
 In
1997, acc to WHO definitions of
normothermia and hypothermia:
Normal range: 36.5–37.51C
Cold stress: 36.0–36.51; cause for concern
Moderate hypothermia: 32.0–36.0
Severe hypothermia: less than 32.0

4.  Hypothermia
can be a problems in
Delivery room resuscitation efforts
During transport of the preterm infant to
the NICU
During certain NICU admitting procedures.

8.  Perinatal
hypothermia to be avoided except in
those who have sustained a significant hypoxicischemic insult.
 In 2006, the AAP’ and AHA Neonatal Resuscitation
Program (NRP) recommended-the first postnatal
temperature should be an axillary temperature of
approximately 36.5 C.
 NRP
recommends - ‘temperature must be
monitored closely due to risk of hyperthermia
during or after ischemia is associated with
progression of cerebral injury. The goal is to
achieve normothermia and avoid iatrogenic
hyperthermia’.

9.  Continuous
temperature
monitoring
initiated as soon as possible after the birth of
the preterm infants.
 NRP recommended- ‘when delivery of a
preterm
baby
is
anticipated,
the
temperature of the room should be
increased’, and to ‘pre-heat the radiant
warmer by turning it on well before birth,
use a head cap, and if the baby is born at
less than 28 weeks gestation, consider
placing him, below the neck, in a reclosable
polyethylene bag, without first drying the
skin.

10. American Society of Heating, Refrigerating and Airconditioning Engineers (ASHRAE) and WHO works
together for delivery room temperatures with hospital
leaders and managers of Labor and Delivery services.
 ASHRAE recommendsSingle room labor-delivery-recovery-postpartum
temperature : 75 °F,
Standard patient room temperature of 75 °F
Recovery room temperature : 75 °F
Nursery temperature : 75 °F.


The guidelines state that Delivery Room temperature
should never be ≤68 °F.

11.  Recommendations
from American Institute of
Architects (AIA), WHO and Recommended
Standards for Newborn ICU- Prevention of
hypothermia is also enhanced by use of
weighing scales built into warmers and
appropriate attention to adequate warming
mechanisms of transport incubators.
 Important aspect- staff education on the
problem of neonatal hypothermia and the
use of preventive strategies, especially in the
ELBW infant.

12.  AAP
colleagues shared the following quality
improvement data regarding hypothermia
(defined as a temperature ≤ 36.41C or ≤
97.61F) at admission to their units from the
delivery room within 30 min of birth (Table
2).
 Data show a high prevalence of hypothermia
among LBW preterm infants, with reported
incidence of at least 25% among infants
<2500 g birth weight, and ≥ 56% in infants
<750 g

13.  Hypothermia
a preventable event in nearly all
infants, even in ELBW
 Deserves special attention –as associated with
significant morbidity and mortality.
 Multicenter clinical trials required to establish best
practices for prevention of hypothermia.
 The delivery room temperature should be at or
higher than that recommended for the labordelivery-recovery-postpartum,
patient
room,
recovery room and nursery, especially for the
preterm infant.

14. Recommendation: every delivery room should
have individual thermostat and humidity control,
as needed for preterm deliveries.
 Delivery room temperatures and humidity should
be documented, and infant’s temperature should
be recorded as soon as possible after birth and
every 10–15 min thereafter until continuous
temperature monitoring has been established.
 Monitoring consider the possibility of extremes in
body temperature in either direction among
ELBW infants.
 Over-warming
can occur and is equally
dangerous.


15. The set points for delivery rooms are consensus-based
and not evidence-based.
 Acc to WHO, ‘adults should not determine the delivery
room temperature according to their own comfort’.
 Discussions with members of the obstetrical team will
be necessary to effect this change in the delivery room,
especially during operative deliveries when gowning is
used.
 It should be remembered that warming the delivery
room above 72 F will be necessary in <2% of deliveries.
 A dedicated room for newborn resuscitation adjacent to
the delivery room in which ambient temperature can be
well controlled.


16. 


Is a significant concern, especially among extremely preterm
infants.
One study- hypothermia among preterm newborns born at or below
1500 g varies from 31 to 78%.
Clinical trials data currently are lacking.

Currently, we recommend the NRP and ASHRAE recommendations
for delivery room temperature management

The goal is to achieve normothermia and avoid iatrogenic
hyperthermia.

The AAP Committee on Fetus and Newborn are working together to
assess the magnitude of this problem and support institution of
measures to prevent hypothermia among preterm neonates.

17. Thank you