1. Thermal protection in neonates

2. Hypothermia Significant problem in neonates at birth and beyond
Contributes to significant morbidities
Mortality rate twice in hypothermic babies
Teaching Aids: ENC
NT-

3. 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-

4. 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-

5. Mechanisms of heat loss
Four ways a newborn may lose heat to
the environment
Convection
Evaporation
Radiation
Conduction
Teaching Aids: ENC
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6. 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
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7. 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-

8. Definition & degrees of hypothermia
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
Teaching Aids: ENC
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9. Temperature recording
Axillary temperature recording for 3 minutes is recommended for routine monitoring
Teaching Aids: ENC
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10. Diagnosis of hypothermia by human touch
Feel by touch
Trunk
Extremities
Interpretation
Warm
Normal
Cold
Cold stress
Hypothermia
Teaching Aids: ENC
NT-

11. Causes of hypothermia The room is too cold
The baby is exposed to cold draft
The newborn is wet
The baby is uncovered , even for short time
The baby is not feeding well
The baby is placed on a cold surface or near cold wall or window
The baby has an infection
Baby has birth asphyxia and does not have energy to keep warm
Mother & baby are not together
Teaching Aids: ENC
NT-

12. 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
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13. Kangaroo mother care (KMC)
Assists in maintaining temperature
Facilitates breastfeeding
Increases duration of breastfeeding
Improves mother-baby bonding
Teaching Aids: ENC
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14. Place baby in this position Then cover with clothes
Kangaroo method
Place baby in this position
Then cover with clothes
Teaching Aids: ENC
NT-

15. Bathing the baby Small&/or LBW: Sick /admitted in nursery: Term baby:
- 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-

16. Dry quickly & thoroughly Give to mother to breast feed
Bathing the baby
Warm room – warm water
Dry quickly & thoroughly
Dress warmly and wrap
Give to mother to breast feed
Teaching Aids: ENC
NT-

17. Cot-nursing in hospital
(mother sick)
Cover adequately
Keep in thermoneutral environment
Monitor temperature 3 hourly during initial postnatal days
Teaching Aids: ENC
NT-

18. Prevention of hypothermia
during 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-

19. 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-

20. 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-

21. 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 C, then hourly for next 4 hours, 2 hourly for 12 hours thereafter
Teaching Aids: ENC
NT-

22. 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-

23. 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-

24. 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: 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-

25. Hyperthermia Temperature >37.50C 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-

26. Hyperthermia How does hyperthermia affect the baby?
Dehydration or loss of body water
Convulsions
Shock
Coma and even death
Teaching Aids: ENC
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27. 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
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28. Management of hyperthermia
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
Teaching Aids: ENC
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29. 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
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30. 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
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31. 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
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32. 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
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