Post on 23-Mar-2018
Thermal protection in neonates
Teaching Aids: ENC NT- 2
Hypothermia
• Significant problem in neonates at birth and beyond
• Contributes to significant morbidities
• Mortality rate twice in hypothermic babies
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Learning objectives
• To describe how to keep a baby warm
• To explain the factors which contribute to heat loss and how they can be prevented
• To teach a mother how to keep her baby warm
Teaching Aids: ENC NT-
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Hypothermia: why are newborns prone?
• Larger surface area per unit body weight
• Decreased thermal insulation due to lack of subcutaneous fat (LBW infant)
• Reduced amount of brown fat (LBW infant)
Teaching Aids: ENC NT-
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Four ways a newborn may lose heat to the environment
Mechanisms of heat loss
Conduction
Radiation
ConvectionEvaporation
Teaching Aids: ENC NT-
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Heat gain: Non-shivering thermogenesis
• Heat is produced by increasing the metabolism especially in brown adipose tissue
• Blood is warmed as it passes through the brown fat and it in turn warms the body
Teaching Aids: ENC NT-
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Neutral thermal environment
Range of environmental temperature in which an
infant can maintain normal body temperature with
minimal basal metabolic rate and least oxygen
consumption
Teaching Aids: ENC NT-
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Normal range
Cold stress
Moderate hypothermia
Severe hypothermia Outlook grave, skilled care urgently needed
Danger, warm baby
Cause for concern
37.5o
36.5o
36.0o
32.0o
Definition & degrees of hypothermia
Teaching Aids: ENC NT-
Axillary temperature recording for 3 minutes is recommended for routine monitoring
Teaching Aids: ENC NT- 9
Temperature recording
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Diagnosis of hypothermia by human touch
Feel by touch Trunk
Feel by touch Extremities
Interpretation
Warm Warm Normal
Warm Cold Cold stress
Cold Cold Hypothermia
Teaching Aids: ENC NT-
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1. The room is too cold
2. The baby is exposed to cold draft
3. The newborn is wet4. The baby is uncovered , even
for short time 5. The baby is not feeding well
6. The baby is placed on a cold surface
or near cold wall or window
7. The baby has an infection
8. Baby has birth asphyxia and does not
have energy to keep warm
9. Mother & baby are not together
Causes of hypothermia
Teaching Aids: ENC NT-
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Prevention of hypothermia at birth
• Conduct delivery in a warm room (>250C)
• Dry baby including head immediately with warm clean towel
• Wrap baby in pre-warmed linen; cover the head and the limbs
• Place the baby in skin-to-skin contact with the mother
• Initiate early breastfeeding
• Postpone bathing
Teaching Aids: ENC NT-
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Kangaroo mother care (KMC)
• Assists in maintaining temperature
• Facilitates breastfeeding
• Increases duration of breastfeeding
• Improves mother-baby bonding
Teaching Aids: ENC NT-
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Kangaroo method
Place baby in this position Then cover with clothes
Teaching Aids: ENC NT-
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Bathing the baby
Small&/or LBW:- Till the cord falls or preferably till 2.5 kg weight
Sick /admitted in nursery:- No bath
Term baby:- Postpone till next day
Teaching Aids: ENC NT-
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Bathing the baby
Warm room – warm water Dry quickly & thoroughly
Dress warmly and wrap Give to mother to breast feed
Teaching Aids: ENC NT-
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Cot-nursing in hospital (mother sick)
• Cover adequately
• Keep in thermoneutral environment
• Monitor temperature 3 hourly during initial postnatal days
Teaching Aids: ENC NT-
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Prevention of hypothermiaduring transport
• Let temperature stabilize before transport• Document temperature and take appropriate action• Carry close to chest, if possible in kangaroo position• Cover adequately, avoid undressing
Teaching Aids: ENC NT-
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Signs and symptoms of hypothermia
Examine the baby`s temperature and activity
Look for • Low temperature
• Limp
• Poor sucking or feeding
• A weak cry
• Slow or shallow respiration
• Slow heart rate ( < 100/min)
Teaching Aids: ENC NT-
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Signs and symptoms (cont..)
• Due to peripheral vasoconstriction - acrocyanosis , cold extremities
• Due to increased metabolism
- hypoglycemia, metabolic acidosis
• Due to increased pulmonary artery pressure- respiratory distress, tachypnea
• Chronic signs- weight loss, failure to thrive
Teaching Aids: ENC NT-
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Management: Cold stress
• Cover adequately - remove cold clothes and replace with
warm clothes
• 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
Teaching Aids: ENC NT-
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Management: Moderate hypothermia
• Skin to skin contact
• Warm room/bed
• Take measures to reduce heat loss
• Provide extra heat
- Room heater
- Radiant warmer, incubator
- Apply warm towels
Teaching Aids: ENC NT-
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Using skin-to-skin contact to re-warm a cold baby
• Make sure the room is warm • Place baby in skin-to-skin contact in a pre-warmed shirt
opening at the front, a nappy, hat and socks • Cover the baby on the mother’s chest with her clothes AND
an additional warmed blanket • Check temperature every 30 minutes• Keep the baby with the mother until the temperature is in the
normal range
Teaching Aids: ENC NT-
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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: 60-80 ml/kg of 10% Dextrose• Oxygen, if needed• Inj.vitamin K 1 mg in term & 0.5 mg in preterm • If still hypothermic, consider antibiotics assuming sepsis Monitor HR, BP, Glucose (if available)
Teaching Aids: ENC NT-
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Hyperthermia
Causes • The room is too hot
• The baby has too many layers of covers / clothes
• Baby is dehydrated because of not feeding properly
• Baby has infection
Teaching Aids: ENC NT-
Temperature >37.50C
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Hyperthermia
How does hyperthermia affect the baby? • Dehydration or loss of body water
• Convulsions
• Shock
• Coma and even death
Teaching Aids: ENC NT-
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Hyperthermia
Symptoms • Baby is Irritable
• Has increased HR & RR
• Has a flushed face
• Skin is hot & dry
• Late stages: apathetic, lethargic and then comatosed
Teaching Aids: ENC NT-
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• Place the baby in a normal temperature environment (25 to 280C), away from any source of heat
• Undress the baby partially or fully, if necessary • Give frequent breast feeds; give breast milk by cup if
unable to suck• If temperature >390C, sponge the baby with tap water;
DO NOT use cold / ice water for sponge• Measure the temperature hourly till it becomes normal
Management of hyperthermia
Teaching Aids: ENC NT-
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Scenario 1: Possible causes of hypothermia in delivery room
You are asked by a senior staff to check if there is a problem in the delivery room. You discover several reasons why the delivery room may be too cold for babies and their mothers.
What is the problem ? List possible reasons What action you will take ?
Teaching Aids: ENC NT-
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Scenario 2: Postnatal ward
You are in-charge of the postnatal ward in a district hospital. You have noticed that mothers are wearing jackets and think the ward is cold.
You spend an afternoon assessing the postnatal ward.
What could be the problem ? List what you have seen
What are the simple doable actions ?
Teaching Aids: ENC NT-
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Scenario 3: Hot weather
The climate is very hot where you live.
What advice can you give to mothers and their families when they take their new baby home, to prevent their baby from becoming overheated?
Teaching Aids: ENC NT-
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Conclusion
• Prevent hypothermia, maintain “Warm chain”
• Ensure closer monitoring and stricter preventive measures for LBW and other at risk neonates
• Early detection and prompt simple interventions
will prevent both hypo & hyperthermia
Teaching Aids: ENC NT-