This document discusses thermal care for newborns. It notes that newborns are homeothermic but can experience hypothermia or hyperthermia. Precise ambient temperature ranges are recommended based on a newborn's weight and age to maintain their thermo-neutral zone. Factors like improper drying, delayed feeding, and an unwarmed room can increase heat loss risk. Precise temperature monitoring and maintenance of the newborn's temperature is important for their health and development. The concept of a "warm chain" of 10 interlinked steps from delivery to discharge is recommended by the WHO to prevent hypothermia in newborns.

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