Hypothermia

• Significant problem in neonates at birth and

beyond ( 15%)
• Mortality rate twice in hypothermic babies
• Significant morbidity & mortality
• Preventable
• Lack of professional alertness of healthcare
providers

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causes of hypothermia

■ Situations causing excessive heat loss

■ Poor ability to conserve
■ Poor metabolic heat production

2
causes of hypothermia

■ Situations causing excessive heat loss

cold environment,
■ wet or naked baby,
■ cold linen,
■ during transport, and
■ procedures bath , blood sampling,
infusion
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causes of hypothermia

■ Poor ability to conserve— LBW, IUGR

■ Poor metabolic heat production-
deficiency of brown fat,
■ CNS damage,
■ hypoxia,
■ hypoglycaemia,
■ sepsis*
4
 Why are newborns prone to
develop hypothermia

• Larger surface area per unit body weight

• Limited heat generating mechanisms(Non

shivering thermogenesis)

• vulnerability to getting exposed, being

dependent others

5
 factors in LBW/SFD

• Larger surface area than term babies

• Poor insulation (lower subcutaneous fat)
• More permeable skin
• Decreased brown fat
• Poor physiological response to cold
• Early exhaustion of metabolic stores like
glucose
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 Thermal balance

Convection
Evaporation
Radiation

Conduction
heat loss skin-0.3c/min
core-0.1c/min

7
 Response to cold

• Muscular activity
• Minimal shivering in term babies
• Metabolic thermogenesis (non shivering
thermogenesis)

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 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
• Effective thermogenesis require—adequate
brown fat, glucose ,oxygen and intact CNS
pathways

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 Neutral thermal environment

Range of environmental temperature in

which an infant can maintain normal
body temperature with least amount
of BMR and oxygen consumption
normal temperature 36.5-37.3
temperature change not more than 0.3 for skin and
Fall of 2 *C==25% heat generation

10
 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)

11
 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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 Axillary temperature in the
newborn ( 0C)
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

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Prevention of hypothermia: Warm chain

1. Warm delivery room 6. Bathing postponed

(>250 C)
7. Appropriate clothing
2. Warm resuscitation
8. Mother & baby
3. Immediate drying
together
4. Skin-to-skin contact
9. Professional alert
5. Breastfeeding
10. Warm transportation
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 Prevention of hypothermia at birth

• Conduct delivery in a warm room( 27.C)

• Dry baby including head immediately with
warm clean towel
• Wrap baby in pre-warmed linen; cover the
head and the limbs
• Place the baby skin to skin on the mother
• Postpone bathing
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 Bathing the baby

Timing of bath Procedure

■ Small&/or LBW: ■ Warm room and warm
Till the cord falls or water
preferably till 2.5 kg ■ Bathe quickly and gently
weight ■ Dry quickly and

■ Sick /admitted in nursery: thoroughly

■ Wrap in a warm, dry
No bath
towel
■ Term baby:
■ Dress and wrap infant
Postpone till next day
■ Use a cap
■ Keep close to mother

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 Bathing the baby

Warm room – warm water Dry quickly & thoroughly

Dress warmly and wrap Give to mother to breast feed

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 Kangaroo Mother care

• Assists in maintaining temperature

• reduces risk of apnea
• reduced risk of infections
• babies cry less and sleeps better(better
neurobehavioral development)
• Facilitates breastfeeding
• Increases duration of breastfeeding
• Improves mother-baby bonding
• better weight gain and early discharge 18
19
The Kangaroo method

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 The Kangaroo method

Place baby in this position Then cover with clothes

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 Cot-nursing in hospital
(mother sick)
• Cover adequately in layering*
• adequate feeding( EBF/assisted)
• Keep in thermoneutral environment

• Monitor temperature 3 hourly during initial

postnatal days

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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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 Signs and symptoms of
hypothermia
• Peripheral vasoconstriction
- acrocyanosis, cold extremities, mottling
- decreased peripheral perfusion
• CNS depression
- lethargy, poor feeding
bradycardia, seizures
apnea

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 Signs and symptoms (cont..)

• Increased pulmonary artery pressure

- respiratory distress, Cynosis

tachypnea, pulmonary haemorrhage

• Chronic signs
- weight loss, failure to thrive

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 Hypothermia

catecholamines release reduced surfactant production

uncoupling of increased BMR pulmonary and peripheral vasoconstriction

beta oxidation

release of FFE
Hypoglycaemia increased o2 requirement
Displaces bilirubin
from albumin
Anaerobic metabolism,
Glycolysis,Hypoxemia,
Hyperbillirubinemia Metabolic acidosis

CNS and cardiac depression28

Complications
■ Hypoglycaemia
■ Bleeding ,DIC
■ Acidosis
■ Hypotension
■ Shock
■ Respiratory distress
■ Pulmonary haemorrhage
■ Apnea
■ Cardiac arrest
■ Death

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 Management: Cold stress
(<36.5)
• 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 and 3 hourly as a routine
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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 (<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
• Manage T A B C*
• IV fluids: 60-80 ml/kg of 10% Dextrose
• Oxygen
• Inj.vitamin K 1mg in term & 0.5 mg in preterm
• If still hypothermic, consider antibiotics assuming sepsis
Monitor HR, BP, Glucose (if available) 32
 Hyperthermia > 37.50C
• Problem in summer months
• May indicate infection in term babies
• Irritable, increased HR & RR
• Flushed face, hot & dry skin
• Apathetic, lethargic and pale
• Stupor, coma, convulsions if temperature > 410C

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 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
• If temperature > 390C, sponge the baby with tap
water; don’t use cold / ice water for sponge
• Measure the temperature hourly till it becomes
normal

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 Conclusion
• Prevent hypothermia, maintain “Warm chain”

• Ensure closer monitoring and stricter preventive

measures for LBW and other at risk neonates

• Early detection and prompt remedial measures

are key for reducing this preventable morbidity
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