NEONATAL

HYPOTHERMIA
DR. HARISH KUMAR REDDY G
INTRODUCTION:
a) Common alteration of thermo-regulatory state in neonates which
occurs when the Axillary temperature decreases below 36.5
Celsius.
b) Estimate of 15% of new born babies develop hypothermia in
developing countries
c) Mortality rate – twice in hypothermia babies.
d) Seen in all climates and regions – temperate or tropical and cold
or hot seasons.

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 FACTORS CONTRIBUTING FOR NEW
BORNS TO BE PRONE TO HYPOTHERMIA
a) Larger surface area per unit body weight. i) Limited heat generality mechanisms( non shivering
A. Term infants = 3 times the BSA that of an adult. thermogenesis).
B. SGA infants = 4 times the BSA that of an adult. j) Vulnerability to getting exposed, being dependent
on others.
b) Large head size in relation to surface area.
c) Low subcutaneous and brown fat.
d) Thin, immature and high permeable skin.
e) Greater water content.
f) Low energy storage.
g) High respiratory rate.
h) Poor thermoregulation.

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FACTORS IN PRE-TERMS
a) Larger surface area than term babies.
b) Poor insulation (lower subcutaneous fat).
c) More permeable skin… 2 or 3 cell layer thinner
d) Less brown fat.
e) Poor physiological response to cold.
f) Early exhaustion of metabolic stores like glucose.
g) Immature hypothalamus
h) Sweat glands initially do not work and are functional by day 14
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EVALUATION OF BODY SURFACE AREA

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THERMO REGULATION IN NEW BORNS
a) Intra uterine life: fetal temperature is 0.5 Celsius higher than
maternal temperature
b) Immediately after birth: infant exposed to outside environment
which is much cooler and the body temperature may fall by 2-4
Celsius the greatest amount of heat being lost in the first 10-20
minutes .
c) Therefore, crucial to prevent prolonged heat loss and to provide
and maintain sufficiently warm environment.

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 WAYS OF HEAT LOSS IN A NEW BORN:
A. Evaporation: C. Convection:
a) Greatest source of heat loss at birth a) Heat loss through contact with cold air
(60%). in the surrounding area.
b) Because liquor amni covering the baby b) Ex: Baby kept near a window or in a cold
evaporates. room
c) Maybe insensible (from skin or D. Radiation:
breathing) or sensible (sensing)
a) Heat loss when the baby placed near
B. Conduction: items that have lower temperature than
a) Heat loss through “direct – contact” that of baby’s body without actual
with a cooler surface. contact.
b) Ex: Baby put on a cold table or cold b) Ex: Baby placed near a cold wall
mattress
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Thermal balance
heat loss skin-0.3c/min
Convection core-0.1c/min
Evaporation
Radiation

Conduction

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 WAYS OF HEAT PRODUCTION:
A. Metabolic processes d) NST is a process that stimulates cellular
respiration that results in high metabolism
B. Muscular activity including crying and and oxygen consumption to produce more
movements heat.
C. Non – shivering thermogenesis: e) The nor adrenaline released from the
a) Heat produced by increasing metabolism in sympathetic nervous system acts on the
brown adipose tissue brown fat and helps in the heat production
b) Blood is warmed as it passes through the by beta oxidation of fat.
brown fat and it in turns warms the body. f) Brown adipose tissue is located in the axilla,
c) When heat loss begins thermo receptors of neck , inter scapular region , supra clavicular
subcutaneous tissue ,spinal cord and region, mediastinum, around the kidneys,
hypothalamus are stimulated and NST is pancreas, trachea and adrenal glands
triggered. D. Peripheral vasoconstriction

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 Causes of hypothermia

Situations causing excessive Poor ability to conserve

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 Hypothermia`
Pathophysiology:
Catecholamines release Reduced surfactant production

Uncoupling of beta pulmonary and peripheral vasoconstriction

Hypoglycaemia increased o2 requirement

Anaerobic metabolism,
Displaces bilirubin Glycolysis,Hypoxemia,
from albumin Metabolic acidosis

CNS and cardiac depression

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Signs and symptoms of
hypothermia
• Peripheral vasoconstriction
- acrocyanosis, cold extremities, mottling, sclerema
- decreased peripheral perfusion
• CNS depression
- lethargy, poor feeding, bradycardia, seizures, apnea
• Increased pulmonary artery pressure
- respiratory distress, Cynosis, tachypnea, pulmonary haemorrhage
• Chronic signs
- weight loss, failure to thrive
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Complications
■ Hypoglycaemia ■ Apnea
■ Bleeding ,DIC ■ Cardiac arrest
■ Acidosis ■ Death
■ Hypotension
■ Shock
■ Respiratory distress
■ Pulmonary haemorrhage

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Temperature recording
• Axillary temperature recording for 3 minutes is recommended for
routine monitoring
• rectal temperature(2min) is unnecessary in most situations
• human touch( back of the fingers)

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Axillary temperature in the
new-borns (Celsius)

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Diagnosis of hypothermia by
human touch
Feel by touch Feel by touch Interpretation
Trunk Extremities

Warm Warm Normal

Warm Cold Cold stress

Cold Cold Hypothermia

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 Management: Cold stress
(<36.5)
• Cover adequately - remove cold • Breast feeding
clothes and replace with
Monitor axillary temperature every ½
warm clothes hour till it reaches 36.50 C, then hourly
for next 4 hours, 2 hourly for 12 hours
• Warm room/bed
thereafter and 3 hourly as a routine
• 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

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Management: Moderate
hypothermia(32.0°C to 35.9°C )
• Skin to skin contact
• Feeding
• Warm room/ warmer
• Take measures to reduce heat loss
• Provide extra heat
- 200 W bulb
- Heater, warmer, incubator
- Apply warm towels
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Management: Severe
hypothermia (<32 Celsius)
• Provide extra heat preferably Dextrose
under radiant warmer or air
• Oxygen
heated incubator
• Inj. vitamin K 1mg in term & 0.5
- rapidly warm till 34 C, then slow
mg in preterm
re-warming
• If still hypothermic, consider
• Take measures to reduce heat antibiotics assuming sepsis
loss Monitor HR, BP, Glucose (if
• Manage T A B C available)
• IV fluids: 60-80 ml/kg of 10%

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Prevention of hypothermia: Warm chain
1. Warm delivery room 9. Professional alert
(>25 C) 10. Warm transportation
2. Warm resuscitation The warm chain is a set of interlinked
procedures to be performed at birth and
3. Immediate drying during the next few hours and days in
4. Skin-to-skin contact order to minimise heat loss in all new
borns .(WHO 1997)
5. Breastfeeding
According to UNICEF such interventions
6. Bathing postponed can help reduce neonatal mortality or
7. Appropriate clothing morbidity by 18 to 45 %.
8. Mother & baby together
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 Bathing the baby
Timing of bath Procedure ■ Use a cap
■ Small&/or LBW: ■ Warm room and warm ■ Keep close to mother
Till the cord falls or water
preferably till 2.5 kg ■ Bathe quickly and gently
weight ■ Dry quickly and
■ Sick /admitted in nursery: thoroughly
No bath ■ Wrap in a warm, dry
■ Term baby: towel
Postpone till next day ■ Dress and wrap infant

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Bathing the baby
Warm room – warm water Dry quickly & thoroughly

Dress warmly Give to mother to breast feed

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Prevention of hypothermia
(during transport)
• Let temperature stabilize before transport
• Document temperature and take remedial measures
• Carry close to chest,
• if possible in kangaroo position
• Cover adequately, avoid undressing
• Use thermocol box with pre-warmed linen or plastic sheet or water
filled mattress with thermostat

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THERMO – NEUTRAL ENVIRONMENT
a) Thermo neutral zone refers to the narrow range of environmental
temperature in which a baby has the lowest basal metabolic rate
and oxygen utilization and the baby has a normal temperature
b) TNZ is different for babies of different gestation and post natal age
c) TNZ is higher for lower gestation and smaller birth weight
a) Higher for early days of life than later age

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THANK YOU!

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