NEONATAL HYPOTHERMIA #BSC NURSING,GENERAL NURSING#

1. NEONATAL HYPOTHERMIA
RANJITA JENA
LECTURER ,SUM NURSING COLLEGE
SIKSHA O ANUSANDHAN UNIVERSITY

2. DEFINITION
Neonatal hypothermia is a common alteration of
thermoregulatory state of neonates which occurs when
axillary temperature falls below 36.50C
(WHO,1997).Normal axillary temperature for a neonate is
36.50C – 37.50C [ 97.80F – 99.60F]

3. Prevalence of Neonatal Hypothermia
 In Nepal a study done on 500 newborns showed that
85% of neonates were hypothermic( body temperature
< 360C) 2 hours after delivery.
 In Nepal, primarily during the winter months, over
80% of the infants born became hypothermic after birth
and 50% remained hypothermic at 24 hours.
 The labour and postnatal wards were cold, at around
20°C (68°F), and this was a significant factor in the
development of hypothermia.
 It is estimated that 15% of the newborn babies develop
hypothermia at birth in developing countries.

4. Factors Responsible For Neonatal Hypothermia
 Large surface area per unit body weight is about 3 times
that of adult and loses twice as much heat per unit area.
(Term infants have 3 times the body surface area to body
mass of an adult while pre term infants and SGA infants
have 4 times the surface area to body mass of an adult).
 Large head size in relation to surface area
 Low subcutaneous and brown fat
 Thin ,immature and highly permeable skin
 Greater water content

5.  Low energy storage
 High respiratory rate
 Poor thermoregulation
 Other risk factors are : cool room, air draught,
delay and inadequate drying of the baby, improper
wrapping, kept in cold surface area, no feeding
well, sick neonate like asphyxiated infants, low
birth weight and preterm infants, infants with
respiratory distress etc.

6. Ways of Heat Loss in Newborn Baby
a. Evaporation : It is the process whereby the baby
loses his body temperature because liquor amino
covering the baby evaporates. Evaporative losses
may be insensible (from skin and breathing) or
sensible (sweating). Other factors that contribute to
evaporative loss are the newborn’s surface area,
vapor pressure and air velocity. This is the greatest
source of heat loss at birth(about 60%).
.

7. b. Conduction : It is the process of heat loss through
direct contact with items that have a lower
temperature .For example : a baby who is put on a
cold table or on a mattress which has a lower
temperature than that of the baby's body. The transfer
of heat between two solid objects that are touching, is
influenced by the size of the surface area in contact
and the temperature gradient between surfaces

8. c. Convection : It is the process of heat loss through
contact with the cold air in the surrounding area. For
example : A baby kept near a window or cold room
with a cooling fan or an air conditioner or an open
room where the wind is blowing directly on his body
would lose heat through convection. It is affected by
the newborn’s large surface area, air flow (draughts,
ventilation systems, etc), and temperature gradient.

9. d. Radiation: It is the process whereby the baby loses
body temperature because he is placed near items
that have lower temperature than that of the baby's
body without actually being in contact with them.
For example : When a baby is kept near a cold wall

10. Methods of Grading Neonatal
Hypothermia
• For monitoring of axillary temperature , Keep
thermometer deep in axilla for full 3 minutes. Normal
temperature 36.5oC-37.5 degree Celsius.
• Mild hypothermia (cold stress) <36.5oC-36.0 degree
Celsius
• Moderate hypothermia <36 oC-32 oC Severe
hypothermia <32 oC B.
• Touch method : This is precise and reliable in the
absence of thermometer. Abdomen skin temperature
is assessed by touch with dorsum of hand.

11. • Abdominal temperature is representative of the core
temperature.
• Findings include : Baby’s feet and hands are warm :
Thermal comfort .
• Peripheries are cold, the trunk is warm : Cold stress
• Peripheries and the trunk both are cold :
Hypothermia

12. Management of Neonatal Hypothermia
A. Mild Hypothermia (cold stress)
 Remove the baby from the source that may be causing
hypothermia such as cold environment, cold clothes, cold
air or wet clothing.
 Cover the baby adequately with warm clothes. Ensure
skin to skin contact with mother, if not possible, kept next
to mother after fully covering the baby.
 Warm the environments including room / bed. Ensure
warm(280-320C) and draught free room.
 Immediately breastfeed the baby. Encourage mother to
breast feed the baby more frequently. If baby cannot breast
fed, give expressed breast milk using an alternative
feeding method.

13.  Monitor axillary temperature every ½ hourly till it
reaches 36.5°, then hourly for next 4 hours, 2 hourly
for 12 hour thereafter. If the temperature of baby is not
rising, check if adequate amount of heat being
provided. Sepsis should be suspected unresponsive
hypothermia.
 Watch for apnea and hypoglycemia.
 Follow up: Ask family to return for follow up visit in
a week. If the baby is feeding well and there are no
other problems requiring hospitalization, discharge the
baby. Advice the mother how to keep the baby warm
at home.

14. B. Moderate to Severe Hypothermia
 Remove wet clothes and rapid rewarming by incubator (air
temperature 35-36°C), preheated radiant warmer or
thermostatically controlled heated mattress set at 37-38°C.
 Room heater or 200 W bulb or infrared bulb can also be used.
 Rapid rewarming is done up to 34°C, then slow rewarming to
36.5°C.
 Set skin temperature at 370C in skin servo mode in radiant
warmer or 1-1.50C higher than the body temperature in an
incubator and should be adjusted as the newborn's temperature
increases.
 In the absence of radiant warmer or incubator- heating lamp,
home based heating methods may be used under supervision.

15.  Where radiant warmer or incubator is not available,
KMC may be the only option. Monitor temperature
every ½ hourly till it reaches 36.50 .
 If rise of temperature has been by 0.5°C per hour then
heating is considered adequate, and temperature
measurement is continued every hourly for next 4
hours and 2 hourly for next 12 hour thereafter.
 If rise of temperature is not adequate, one should
check the heating technique.

16.  If temperature doesn’t improve provide additional heat. Sepsis
should be suspected unresponsive hypothermia.
 Encourage mother to breast feed the baby more frequently. If
baby cannot breast fed, give expressed breast milk using an
alternative feeding method

17. • Assess the baby
• Look for emergency signs ( respiratory rate less than 20 breaths
per minute or greater than 60 breaths per minute or not breathing,
gasping ,chest indrawing, grunting on expiration and shock) every
hours and provide treatment as necessary.
• Parental anxiety is greatly increased, particularly at the sight of
baby in an incubator for being unable to maintain body
temperature.

18. • Therefore, parents need reassurance concerning their
child's progress in temperature maintenance and
procedures carried out to make him warm and
comfortable.
• If the feeding is well, temperature remains within the
normal range and there are no other problems
requiring hospitalization, discharge the baby. Advise
the mother how to keep the baby warm at home

19. C. Supportive Measures
 Prompt detection and management of hypoxia, hypo perfusion and
hypoglycemia.
 Measure blood glucose. If the blood glucose is less than 45 mg/dl (
2.6 mmol), treat for low glucose.
 10 % IV Dextrose infusion in 1/5 NS at 4-6 mg/kg/min or 60-80
ml/kg/day. If perfusion is poor , give 20ml/kg of RL or NS over 5
minutes. Provide oxygen if moderate to severe hypothermia.
 Watch for apnea, hypoxia and hypoglycemia during rewarming.

20.  IV vitamin K 1 mg IM in term and 0.5mg in preterm babies ,
if not given earlier.
 If hypothermia is associated with infection, start appropriate
antibiotics.
IV Ampicillin : 50 mg/kg plus.
IV Gentamicin : 6 mg/kg or IV Cefotaxim : 50 mg/kg or
IV Amikacin : 5 mg/kg for 5 to 7 days.

21. 10 steps of warm chain
 Warm delivery room
 Warm resuscitation
 Immediate drying
 Skin to skin contact
 Breastfeeding
 Postpone weighing and bathing

22.  Appropriate clothing/ blanket
 Mother and newborn together
 (rooming-in, bed in), Warm transportation
 Training and raising awareness

23. Prevention of Neonatal Hypothermia
• The "warm chain " is a set of interlinked procedures to be
performed at birth and during the next few hours and days
after birth in order to minimize heat loss in all newborns
(WHO,1997).
• The baby must be kept warm at the place of birth (home or
hospital) and during transporation from home to hospital or
within hospital.
• Satisfactory control of the baby's temperature demands both
prevention of heat loss and providing extra heat using an
appropriate source.
• Failure to implement any one of these procedures will break
the chain and put the newborn at the risk of getting cold

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