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Newborn infant

Newborn infant. By : Dr.Sanjeev. Thermal protection in newborn. Due to reduced subcutaneous and brown fat Brown fat : - Site : adrenal glands, kidneys , nape of neck, interscapular and axillary regions Function : - heat production brown fat . metabolism. Heat production.

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Newborn infant

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  1. Newborn infant By : Dr.Sanjeev

  2. Thermal protection in newborn • Due to reduced subcutaneous and brown fat Brown fat : - • Site : adrenal glands, kidneys , nape of neck, interscapular and axillary regions • Function : - heat production brown fat metabolism Heat production

  3. Non – shivering thermogenesis : metabolism Heat production • Brown fat Blood becomes warm Transfer heat to other parts of the body

  4. Heat loss : • Evaporation : - due to evaporation of amniotic fluid from skin surface. • Conduction : - by coming in contact with cold objects –cloth , tray etc. • Convection : - by air current in which cold air replaces warm air around baby – open windows , fan • Radiation : - to colder solid objects in vicinity such as walls.

  5. Physiology : Cold stress Stimulate Hypothalamic center Skin receptor - Increase norepinephrine secretion - Stimulation of sympathetic nervous system causes - Lipolysis of brown fat to release heat - increase HR : increase oxygen to meet the high metabolic needs of nonshivering thermogenesis - Peripheral vasoconstriction – divert blood from the skin towards the organ that drive thermogenesis

  6. NORMAL : MILD HYPOTHERMIA : MODERATE HYPOTHERMIA : SEVERE HYPOTHERMIA : 36.5 – 37 C Less than 36.5 to 36C Less than 36 – 32 C Less than 32 C Range of Temperature

  7. Measurement of body temperature Sites of assessment: oral: under tongue, 3min. Axillae: inside axillary folds 2 – 3 min. (0.5ºC to be added) Rectal: inside anal canal 1-3min. (0.5ºC to be subtracted) Tympanic: busy ambulatory clinic (obtained within one seconds)(0.5ºC to be subtracted) For routine : Axillary

  8. Prevention of hypothermia . 1. In the delivery room 3. Careful bathing of the baby 5 . Temperature maintenance during transport 4. cot- nursing in hospital (mother sick) 2 . Kangaroo mother care (KMC)

  9. In the delivery room : • Conduct delivery in a warm room • Immediately dry newborn with a clean warm towel • Use another warm towel to wrap the baby in two layers • Later, clothe the baby ensuring that the head is well covered

  10. Kangaroo mother care (KMC) • KMC is a powerful, easy-to-use method to promote the health and wellbeign of low birth weight babies. its features are : - • Early, continuous and prolonged skin to skin contact between the mother and the baby • Exclusive breastfeeding Healthful effects: helps in maintaining • temperature of infant • Facilitates breastfeeding • Reduces infection • Improves mother – infant bonding

  11. Instituting KMC • All babies less than 2000g • Place the baby naked , upright inside mother`s clothing against skin • Let baby suckle at breast as often as he wants, but at least every 2 hourly • Sleep propped up so that the baby stays upright • Make sure the baby stays warm all times. If environment is cool , dress the baby with extra clothing and cover his head. • When mother wants to bathe or rest , ask the father or another family member to ``kangaroo`` the baby or wrap infant in several layers of warm clothing, covered • Take baby for regular check – ups for vaccination and weight record.

  12. Careful bathing of the baby : • Bathing should be avoided for at least 6 hours after birth • Avoided in LBW neonates till they reach 2500g weight • Sponging is good enough to clean the baby Cot nursing in hospital (mother sick ): - adequately clothe the baby (including head , extremities) - monitor baby temperature frequently at least 3 hourly during the initial postnatal days

  13. Temperature maintenance during transport : • Let baby`s temperature stabilise before transport • Cary the baby close to chest of mother • Cover head , legs and hands

  14. HYPOTHERMIA : CLINICAL FEATURES : Peripheral vasoconstriction – • Cool extremities • Decreased peripheral perfusion CNS depression • Lethargy • Bradycardia • Poor feeding Increased metabolism • Hypoglycemia • Hypoxia • Metabolic acidosis Chronic signs • Weight loss

  15. Management of hypothermia: • Confirm the diagnosis of hypothermia by recording actual body temperature • Rewarmed as quickly as possible Choices includes : - • skin – to – skin contact • A warm room or bed • A 200 watt bulb • A radiant heater or an incubator

  16. Moderate hypothermia : • Skin – to – skin contact (warm room and warm bed ) • Monitor temperature every 15 – 30minutes • Convection warmed incubators • Radiant warmers

  17. Severe hypothermia • Use air – heated incubator • Once temperature reaches 34 degree rewarming process should down • Start 10 % dextrose, IV Vit. K and provide oxygen

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