High risk neonate

Thermoregulation
 Thermoregulation:
• Mechanisms by which the infant tries to balance heat production
and heat loss to accommodate the thermal environment .
• Along with the establishment of respiration, the most crucial need
of the low-birth-weight (LBW) infant is external warmth.

• Prevention of heat loss in the distressed infant is essential for

survival, and maintaining a neutral thermal environment is a
challenging aspect of neonatal intensive nursing care.

• Heat production is a complicated process that involves the

cardiovascular, neurologic, and metabolic systems
 PRETERM VS TERM

• Diminished capacity for heat production

• Large body surface area
• Immature epidermal layer…increases Infant water loss (IWL)
• Little SC fat
• Little brown fat stores
• Limited skin capillary reflex
• Immature nervous system
• Comorbidities‫ اﻷﻣﺮاض اﻟﻤﺼﺎﺣﺒﺔ‬: î met rate &o2 demands
• Small muscle mass
 COLD STRESS
• When neonates are in an environment below
thermoneutral temperature, they respond by
vasoconstriction to minimise heat losses, followed by a rise
in metabolic rate to increase heat production. This
condition, physiologically termed cold stress, usually occurs
before hypothermia
 COLD STRESS
The infant senses heat loss as a stress and
responds with increased heat production and peripheral
vasoconstriction, with centralization of circulation, in an effort
to maintain the core temperature ‫درﺟﺔ اﻟﺤﺮارة اﻷﺳﺎﺳﻴﺔ‬

• The immature neonate, who cannot increase activity and

lacks a shivering response, produces heat mainly through
increasing metabolic rate.

• Some heat is generated by liver, heart, brain, and skeletal

muscles, but the major source of increased heat production
during cold stress is nonshivering thermogenesis
 NONSHIVERING THERMOGENESIS
• Exposure to cold →→stimulates skin &core temp sensors (along spinal
cord & hypothalamus) →→

hypothalamus→→stimulates CNS →norepinephrine

production→→free fatty acid rlease in brown fat (BF)along with
thermogenin enzyme →→combustion of mitochondia of BF→→HEAT
PRODUCTION

• Lipoprotein enzyme also provides triglyceride substrate‫ رﻛﻴﺰة‬for heat

production
 Neutral thermal environment
• Is the environment that maintains core body temp with minimal O2
&caloric consumption thus energy is conserved for other basic
functions& for growth

• This can be maintained using:

1. Incubators

2. Radiant warming panel

3. Open bassinet with cotton blankets

‫ اﻟﻌﻮاﻗﺐ اﻟﻤﺤﺘﻤﻠﺔ‬Potential consequences
Non-esterified fatty acids (NEFA) are molecules released from
triglycerides by the action of the enzyme lipase and are
transported in the blood bound to albumin. They contribute only a
small proportion of the body's fat; however provide a large part of
the body's energy.

Atelectasis, the collapse ‫ ﻳﻨﻬﺎر‬of part or all of a lung, is caused by a

blockage of the air passages (bronchus or bronchioles) or by
pressure on the lung. Risk factors for atelectasis include anesthesia,
prolonged bed rest with few changes in position, shallow breathing
and underlying lung disease.

What causes unconjugated hyperbilirubinemia?

Unconjugated hyperbilirubinemia usually results from
dysregulation in the bilirubin metabolism that includes increased
production, impaired hepatic uptake, and decreased conjugation of
bilirubin