3. Objectives:
Rationale of this topic
Temperature control
Pathophysiology/Mechanism
Risk of hypothermia in preterm/term babies
Aetiology of hypothermia
Management
4. RATIONALE OF THIS TOPIC
Hypothermia increases morbidity and mortality.
Preterm neonates - high risk of hypothermia .
Each degree drop in temperature ~28%
mortality ; chances of sepsis
11. 11
DIFFERENCE BETWEEN BROWN FAT AND WHITE FAT
Features Brown Fat White Fat
Vacuoles/cells Many One
Vascularity Good Poor
Nerve Fibres Many Few
Mitochondria Many Few
Stimulus for
activation
Cold Starvation
Function Heat Production Nutrition
12. Normal Temperature
• The temperature of newly born infants
should be maintained between 36.5 and
37.5 °C (97.70F-99.5 o F )after birth
13. NEUTRAL THERMAL ENVIRONMENT
Range of environmental temperature in which
an infant can maintain normal body
temperature with the least amount of basal
metabolic rate and oxygen consumption and
baby thrives well.
14. • Neonatal hypothermia: An universal issue
• After birth, newborns must adapt to their
relatively cold environment by the metabolic
production of heat
15. Etiology of Hypothermia
E= Early bathing
P= Prematurity, Peripheral circulatory failure, Panhypopitutarism
I = Infection
C= Cold exposure, CNS Damage
A = Adrenal insufficiency, Asphyxia
L= Low Oxygen
H = Hypoglycemia
16. WHYNEWBORNARE PRONETO DEVELOP
HYPOTHERMIA?
1. A higher ratio of skin
surface area to weight
2. Highly permeable skin
Increased trans epidermal
water loss
3. Decreased subcutaneous
fat
4. Less stores of brown fat
and decreased glycogen
stores
5. Poor vasomotor control
6. Challenges with
adequate caloric intake to
provide nutrients for
thermogenesis and growth
7. Limited oxygen delivery
if pulmonary conditions
coexist
17. MECHANISMS OF HEAT LOSS
RADIATION.
Infant to a colder object in the environment.
CONVECTION.
Skin to moving air.
The amount lost depends on air speed and temperature.
18. MECHANISMS OF HEAT LOSS
EVAPORATION.
Heat is lost through conversion of water to gas.
CONDUCTION.
Heat is lost due to transfer of heat from the
infant to the surface on which he or she lies
Wet infants in the delivery room are especially
susceptible to evaporative heat loss.
19. Four ways a newborn may lose heat to the environment
Mechanisms of heat loss
Conduction
Radiation
Convection
Evaporation
20. monitoring
• Measurement of rectal temperature
is unnecessary in most
situations
NEWBORN RESPONSE TO COLD STRES
22. Normal range
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COLD STRESS
MODERATE
HYPOTHERMIA
SEVERE
HYPOTHERMIA
Outlook grave,
skilled care urgently
needed
Danger, warm
baby
CAUSE FOR
CONCERN
37.5
o
36.5
o
36.0
o
32.0
o
Axillary temperature in the
newborn (0C)
30. Preventionof hypothermiaat birth
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Conduct delivery in a warm room
Dry baby including head immediately with
warm clean towel
Wrap baby in pre-warmed linen; cover the
head and the limbs
Place the baby skin to skin on the mother
Postpone bathing
31. KANGAROO CARE
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• Assists in maintaining temperature
• Facilitates breastfeeding
• Increases duration of
breastfeeding
• Improves mother-baby bonding
33. BATHING THE BABY
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Timing of bath
Small&/or LBW:
Sick /admitted in
nursery: No bath
Term baby:
Postpone till next day
Procedure
Warm room and
warm water
Bathe quickly and
gently-start with trunk,
concluding with head
Dry quickly and
thoroughly
Wrap in a warm, dry
towel
Dress and wrap infant
Use a cap
Keep close to mother
34. Bathing the
baby
Warm room – warm water Dry quickly & thoroughly
Dress warmly and wrap Give to mother to breast feed
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35. PREVENTIONOF HYPOTHERMIA (DURING
TRANSPORT)
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Let temperature stabilize before transport
Document temperature and take remedial
measures
Carry close to chest, if possible in kangaroo
position
Cover adequately, avoid undressing
Use thermocol box with pre-warmedlinen, plastic
sheet or water filled mattress with thermostat
36. Management: Cold stress
Cover adequately - remove cold clothes and replace
with warm
Warm room/bed
Take measures to reduce heat loss
Ensure skin-to-skin contact with mother; if not
possible, keep next to mother after fully covering the
baby
Breast feeding
Monitor axillary temperature every ½ hour till it reaches 36.50
C, then hourly for next 4 hours, 2 hourly for 12 hours thereafter
and 3 hourly as a routine
38. Management: Severe hypothermia (<320C )
• Provide extra heat preferably under radiant warmer or
air heated incubator
• - rapidly warm till 340C, then slow re-warming
• Take measures to reduce heat loss
• IV fluids
• Oxygen, Inj.vitamin K - 1mg in term & 0.5 mg in preterm
• If still hypothermic, consider
sepsis and treat with antibiotics.
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43. Conclusion
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• Prevent hypothermia, maintain “Warm
chain”
• Ensure closer monitoring and stricter
preventive measures for LBW and other at
risk neonates
• Early detection by human touch and prompt
remedial measures are key for reducing this
preventable morbidity
