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Thermal protection in neonates

PowerPoint · PPT file · Web view · 2014-03-13Thermal protection in neonates NH- NH- NH- NH- NH- NH- NH- NH- NH- NH- NH- * Teaching Aids: ENC NT- * Hypothermia Significant problem

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Page 1: PowerPoint · PPT file · Web view · 2014-03-13Thermal protection in neonates NH- NH- NH- NH- NH- NH- NH- NH- NH- NH- NH- * Teaching Aids: ENC NT- * Hypothermia Significant problem

Thermal protection in neonates

Page 2: PowerPoint · PPT file · Web view · 2014-03-13Thermal protection in neonates NH- NH- NH- NH- NH- NH- NH- NH- NH- NH- NH- * Teaching Aids: ENC NT- * Hypothermia Significant problem

Teaching Aids: ENC NT- 2

Hypothermia

• Significant problem in neonates at birth and beyond

• Contributes to significant morbidities

• Mortality rate twice in hypothermic babies

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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-

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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-

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Four ways a newborn may lose heat to the environment

Mechanisms of heat loss

Conduction

Radiation

ConvectionEvaporation

Teaching Aids: ENC NT-

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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-

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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-

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Normal range

Cold stress

Moderate hypothermia

Severe hypothermia Outlook grave, skilled care urgently needed

Danger, warm baby

Cause for concern

37.5o

36.5o

36.0o

32.0o

Definition & degrees of hypothermia

Teaching Aids: ENC NT-

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Axillary temperature recording for 3 minutes is recommended for routine monitoring

Teaching Aids: ENC NT- 9

Temperature recording

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Diagnosis of hypothermia by human touch

Feel by touch Trunk

Feel by touch Extremities

Interpretation

Warm Warm Normal

Warm Cold Cold stress

Cold Cold Hypothermia

Teaching Aids: ENC NT-

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1. The room is too cold

2. The baby is exposed to cold draft

3. The newborn is wet4. The baby is uncovered , even

for short time 5. The baby is not feeding well

6. The baby is placed on a cold surface

or near cold wall or window

7. The baby has an infection

8. Baby has birth asphyxia and does not

have energy to keep warm

9. Mother & baby are not together

Causes of hypothermia

Teaching Aids: ENC NT-

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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-

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Kangaroo mother care (KMC)

• Assists in maintaining temperature

• Facilitates breastfeeding

• Increases duration of breastfeeding

• Improves mother-baby bonding

Teaching Aids: ENC NT-

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Kangaroo method

Place baby in this position Then cover with clothes

Teaching Aids: ENC NT-

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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-

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Bathing the baby

Warm room – warm water Dry quickly & thoroughly

Dress warmly and wrap Give to mother to breast feed

Teaching Aids: ENC NT-

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Cot-nursing in hospital (mother sick)

• Cover adequately

• Keep in thermoneutral environment

• Monitor temperature 3 hourly during initial postnatal days

Teaching Aids: ENC NT-

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Prevention of hypothermiaduring 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-

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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-

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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-

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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-

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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-

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Using skin-to-skin contact to re-warm 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-

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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• 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-

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Hyperthermia

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-

Temperature >37.50C

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Hyperthermia

How does hyperthermia affect the baby? • Dehydration or loss of body water

• Convulsions

• Shock

• Coma and even death

Teaching Aids: ENC NT-

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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-

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• 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

Management of hyperthermia

Teaching Aids: ENC NT-

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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-

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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-

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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-

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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 simple interventions

will prevent both hypo & hyperthermia

Teaching Aids: ENC NT-