Hypothermia

Significant problem in neonates at birth

and even at 24 hrs of age and beyond
Mortality rate twice in hypothermic
babies

Contributes to significant morbidity & mortality

Why are newborns prone to

develop hypothermia ?

Larger surface area per unit body weight

Decreased thermal insulation due to lack
of subcutaneous fat
Reduced amount of brown fat (LBW
infant )

Non shivering thermogenesis

Heat is produced by increasing

metabolism, especially in brown adipose
tissue
Blood is warmed as it passes through the
brown fat, and it in turn warms the body

Four ways a newborn may lose heat to the environment

Warm chain

Warm delivery room

(>25oC)
Warm resuscitation
Immediate dry
Skin-to-skin contact
breastfeeding

Bathing postponed
Appropriate
clothing
Mother & baby
together
Warm
transportation
Professional alert

Neutral thermal environment

Range of environmental temperature in
which an infant can maintain normal body
temperature with the least amount of
basal metabolic rate oxygen consumption

Axillary temperature in
the newborn infant ( oC )

Temperature recording

Axillary temperature recording for 3

minutes is recommended for routine
monitoring
Dont record rectal temperatur in all
babies as a standard protocol
Record rectal temperature in a sick
hypothermic neonate

Normothermic baby *
Warm turnk
Warm and pink soles

* Human touch

Prevention of hypothermia at birth

Delivery in warm room

Dont bathe immediately after birth
Dry baby immediately with warm clean
towel
Wrap baby in pre-warmed cloth, cover
head
Keep next to mather

Kangaroo care

Assists in maintaining temperature

Facilitates breastfeeding
Increasing duration of breastfeeding
Improved mother baby bonding

The Kangaroo method

Bathing the baby

Warm room and warm water

Bathe quickly and gently
Dry quickly and thoroughly
Wrap in a warm, dry towel
Dress and wrap infant
Use a cap
Keep close to mother

Cot nursing in hospital

Cover adequately
Keep in thermoneutral environment
Monitor temperature 3 hourly during
initial postnatal days

Signs and symptoms of

hypothermia

Peripheral vasoconstriction
- acrocyanosis, cold extremities
- decreased perfusion
CNS depression
- lethargy, bradycardia, apnea, poor feeding
Increased metabolism
- hypoglycemia, hypoxia, acidosis
- lethargy, bradycardia, apnea,

Prevention of hypothermia
(During Transport )

Let temperature stabilities always before

transport
Document temperature and take remedial
measures
Carry close to chest
Cover adequately, avoid undressing
Use thermocol box with prewarm linen or plastic
sheet or water filled mattress with thermostat

Management : Cold stress

Cover adequately remove cold clothes

and replace with with warm clothes
Warm room/bed
Take measures to reduce heat lose
Keep next to mother
Skin-to-skin contact
Breastfeeding

Signs and symptoms ( cont.)

Increased pulmonary artery presure

- distress, tachypnea
Chronic signs
- Weight loss, poor weight gain

Management : severe hypothermia

Provide extra heat

* rapidly warm till 34 oC, then slow
Take measures to reduce heat loss
IV fluids 60-80 ml/kg 10% dextrose
Inj vit K, oxygen
If still hypothermic consider antibiotics

Management : Moderate hypothermia

Skin to skin contact

Warm room/bed
Take measures to reduce heat loss
Provide extra heat
* Apply warm heat
* 200 W bulb
* Heater, warmer, incubator

Hyperthermia > 37.5oC

Problem in summer months

Irritable, increase HR, RR
Flushed face
Hot & dry skin
Apathetic, lethargic and pale
Stupor, coma, convulsions if temperature
> 41oC

Conclusions
Maintain

Warm Chain
Early detection by human touch
and prompt remedial measures
are key for reducing this
preventable morbidity