1. Nov 2007 ACoRN © 2005-07 Thermoregulation Sequence

2. Nov 2007ACoRN © 2005-07

3. Nov 2007ACoRN © 2005-07 A lerting signs C ore steps O rganization of care R esponse N ext steps Thermoregulation Sequence S pecific management

4. Nov 2007ACoRN © 2005-07 Alerting Signs

5. Nov 2007ACoRN © 2005-07 Hypothermia All newborns are at risk for temperature instabilityAll newborns are at risk for temperature instability Babies at increased risk for hypothermia include:Babies at increased risk for hypothermia include: –unwell –preterm, especially LBW (<2000g) and VLBW (<1500g) –SGA –open lesions –ambient temperature is < 23 o C or air drafts exist –being cared for by us!

6. Nov 2007ACoRN © 2005-07 Hypothermia Cold stress can cause: irritable (initially) / lethargicirritable (initially) / lethargic pale, mottledpale, mottled metabolic acidosismetabolic acidosis hypoglycemia / hyperglycemiahypoglycemia / hyperglycemia respiratory distress, apnea, tachypnearespiratory distress, apnea, tachypnea bradycardia / tachycardiabradycardia / tachycardia vasoconstriction, hypoxia, shockvasoconstriction, hypoxia, shock

7. Nov 2007ACoRN © 2005-07 Hyperthermia Causes include:Causes include: –iatrogenic –maternal epidural –maternal hyperthermia –infection –CNS disorders –administration of PgE 1 Babies with intrapartum or neonatal hyperthermia are at increased risk of neurodevelopmental complicationsBabies with intrapartum or neonatal hyperthermia are at increased risk of neurodevelopmental complications

8. Nov 2007ACoRN © 2005-07 Core Steps

9. Nov 2007ACoRN © 2005-07 Organization of Care and Response

10. Nov 2007ACoRN © 2005-07 Specific Management

11. Nov 2007ACoRN © 2005-07 Choosing initial incubator temperature in first 12 hours of age Birth weight (grams) Air temperature setting o C (double wall, humidified incubator) < 750 39.5 (37.5) 750 to 1000 39.0 (37.0) 1000 to 1200 37.5 1200 to 1500 36.5 1500 to 2000 35.5 > 2000 34 Adapted from: Jaimovich DG, Vidyasagar D. Handbook Pediatric and Neonatal Transport Medicine (2d Edition). Philadelphia: Hanley & Belfus, Inc. 2002, p. 483 Initial incubator temperature

12. Nov 2007ACoRN © 2005-07 Heat loss

13. Nov 2007ACoRN © 2005-07 Heat loss prevention Conduction Pre-warm beddingPre-warm bedding Cover weigh scaleCover weigh scale Change wet bedding as soon as possible (eg oxyhoods)Change wet bedding as soon as possible (eg oxyhoods)Evaporation Use medium to high humidity in incubatorsUse medium to high humidity in incubators Place baby < 29 weeks gestation in plastic bagPlace baby < 29 weeks gestation in plastic bag Convection Ambient temperature ~ 25 o CAmbient temperature ~ 25 o C Avoid air drafts: air vents, open/swinging doorsAvoid air drafts: air vents, open/swinging doorsRadiation Flexed nested positionFlexed nested position Double wall incubatorDouble wall incubator

14. Nov 2007ACoRN © 2005-07 Keeping warm

15. Nov 2007ACoRN © 2005-07 Questions?