Thermal protection in
neonates
Hypothermia
• Significant problem in neonates at birth and
beyond
• Contributes to significant morbidities
• Mortality rate twice in hypothermic babies
Teaching Aids: ENC
NT- 2
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
Teaching Aids: ENC
NT- 3
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)
Teaching Aids: ENC
NT- 4
Mechanisms of heat loss
Convection
Evaporation
Radiation
Conduction
Four ways a newborn may lose heat to
the environment
Teaching Aids: ENC
NT- 5
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
Teaching Aids: ENC
NT- 6
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
Teaching Aids: ENC
NT- 7
Definition & degrees of hypothermia
Normal range
37.5o
36.5o
Cold stress
Cause for concern
36.0o
Moderate hypothermia
Severe hypothermia
Teaching Aids: ENC
Danger, warm baby
32.0o
Outlook grave, skilled
care urgently needed
NT- 8
Temperature recording
Axillary temperature
recording for 3 minutes is
recommended for routine
monitoring
Teaching Aids: ENC
NT- 9
Diagnosis of hypothermia by
human touch
Feel by touch
Trunk
Warm
Feel by touch
Extremities
Warm
Interpretation
Warm
Cold
Cold stress
Cold
Cold
Hypothermia
Teaching Aids: ENC
Normal
NT- 10
Causes of hypothermia
1.
The room is too cold
6.
The baby is placed on a cold surface
or near cold wall or window
The baby is exposed to cold
draft
7.
The baby has an infection
3.
The newborn is wet
8.
Baby has birth asphyxia and does not
4.
The baby is uncovered ,
even for short time
2.
have energy to keep warm
9.
5.
Mother & baby are not together
The baby is not feeding well
Teaching Aids: ENC
NT-11
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
Teaching Aids: ENC
NT-12
Kangaroo mother care (KMC)
• Assists in maintaining temperature
• Facilitates breastfeeding
• Increases duration of breastfeeding
• Improves mother-baby bonding
Teaching Aids: ENC
NT-13
Kangaroo method
Place baby in this position
Teaching Aids: ENC
Then cover with clothes
NT-14
Bathing the baby

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
Teaching Aids: ENC
NT-15
Bathing the baby
Warm room – warm water
Dry quickly & thoroughly
Dress warmly and wrap
Give to mother to breast feed
Teaching Aids: ENC
NT-16
Cot-nursing in hospital
(mother sick)
• Cover adequately
• Keep in thermoneutral environment
• Monitor temperature
postnatal days
Teaching Aids: ENC
3
hourly
during
initial
NT-17
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
Teaching Aids: ENC
NT-18
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)
Teaching Aids: ENC
NT-19
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
Teaching Aids: ENC
NT-20
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
Teaching Aids: ENC
NT-21
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
Teaching Aids: ENC
NT-22
Using skin-to-skin contact to rewarm 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
Teaching Aids: ENC
NT-23
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)
Teaching Aids: ENC
NT-24
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
Teaching Aids: ENC
NT-25
Hyperthermia
How does hyperthermia affect the baby?
• Dehydration or loss of body water
• Convulsions
• Shock
• Coma and even death
Teaching Aids: ENC
NT-26
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
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
Teaching Aids: ENC
NT-28
Scenario 1: Possible causes of
hypothermia in delivery room
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 ?
Teaching Aids: ENC
NT-29
Scenario 2: Postnatal ward
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 ?
Teaching Aids: ENC
NT-30
Scenario 3: Hot weather
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?
Teaching Aids: ENC
NT-31
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
Teaching Aids: ENC
NT-32