Thermal protection in neonates

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 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 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) NT-

5. Mechanisms of heat loss Four ways a newborn may lose heat to the environment Convection Evaporation Radiation Conduction NT-

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 NT-

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 NT-

8. 37.5o Normal range 36.5o Cold stress Cause for concern 36.0o Moderate hypothermia Danger, warm baby 32.0o Severe hypothermia Outlook grave, skilled care urgently needed Definition & degrees of hypothermia NT-

9. Temperature recording Axillary temperature recording for 3 minutes is recommended for routine monitoring NT-

10. Diagnosis of hypothermia by human touch NT-

11. 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 Causes of hypothermia 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 NT-

13. Kangaroo mother care (KMC) • Assists in maintaining temperature • Facilitates breastfeeding • Increases duration of breastfeeding • Improves mother-baby bonding NT-

14. Kangaroo method Place baby in this position Then cover with clothes NT-

15. 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 Bathing the baby NT-

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

17. Cot-nursing in hospital (mother sick) • Cover adequately • Keep in thermoneutral environment • Monitor temperature 3 hourly during initial postnatal days 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 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) 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 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 36.50 C, then hourly for next 4 hours, 2 hourly for 12 hours thereafter 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 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 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: 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) 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 NT-

26. Hyperthermia • How does hyperthermia affect the baby? • Dehydration or loss of body water • Convulsions • Shock • Coma and even death Teaching Aids: ENC NT- 26

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 NT- 27

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 NT-

29. 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 ? Scenario 1: Possible causes of hypothermia in delivery room NT-

30. 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 ? Scenario 2: Postnatal ward NT-

31. 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? Scenario 3: Hot weather NT-

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 NT-