1. Newborn infant By : Dr.Sanjeev

2. Thermal protection in newborn Due to reduced subcutaneous and brown fat Brown fat : - Site : adrenal glands, kidneys, nape of neck, interscapular and axillary regions Function : - heat production brown fat metabolism Heat production

3. Non – shivering thermogenesis : Brown fat metabolism Heat production Blood becomes warm Transfer heat to other parts of the body

4. Heat loss : Evaporation : - due to evaporation of amniotic fluid from skin surface. Conduction : - by coming in contact with cold objects –cloth, tray etc. Convection : - by air current in which cold air replaces warm air around baby – open windows, fan Radiation : - to colder solid objects in vicinity such as walls.

6. Physiology : Skin receptor Cold stress Stimulate Hypothalamic center - Stimulation of sympathetic nervous system - Increase norepinephrine secretion causes - Lipolysis of brown fat to release heat - increase HR : increase oxygen to meet the high metabolic needs of nonshivering thermogenesis - Peripheral vasoconstriction – divert blood from the skin towards the organ that drive thermogenesis

7. Range of Temperature NORMAL : MILD HYPOTHERMIA : MODERATE HYPOTHERMIA : SEVERE HYPOTHERMIA : 36.5 – 37 C Less than 36.5 to 36C Less than 36 – 32 C Less than 32 C

8. Measurement of body temperature Sites of assessment : oral: under tongue, 3min. Axillae:inside axillary folds2 – 3 min. (0.5ºC to be added) Rectal: inside anal canal 1-3min. (0.5ºC to be subtracted) Tympanic: busy ambulatory clinic (obtained within one seconds) (0.5ºC to be subtracted) For routine : Axillary

9. Prevention of hypothermia. 1. In the delivery room 2. Kangaroo mother care (KMC) 3. Careful bathing of the baby 4. cot- nursing in hospital (mother sick) 5. Temperature maintenance during transport

10. In the delivery room : Conduct delivery in a warm room Immediately dry newborn with a clean warm towel Use another warm towel to wrap the baby in two layers Later, clothe the baby ensuring that the head is well covered

11. Kangaroo mother care (KMC) KMC is a powerful, easy-to-use method to promote the health and wellbeign of low birth weight babies. its features are : - Early, continuous and prolonged skin to skin contact between the mother and the baby Exclusive breastfeeding Healthful effects : helps in maintaining temperature of infant Facilitates breastfeeding Reduces infection Improves mother – infant bonding

12. Instituting KMC All babies less than 2000g Place the baby naked, upright inside mother`s clothing against skin Let baby suckle at breast as often as he wants, but at least every 2 hourly Sleep propped up so that the baby stays upright Make sure the baby stays warm all times. If environment is cool, dress the baby with extra clothing and cover his head. When mother wants to bathe or rest, ask the father or another family member to ``kangaroo`` the baby or wrap infant in several layers of warm clothing, covered Take baby for regular check – ups for vaccination and weight record.

13. Careful bathing of the baby : Bathing should be avoided for at least 6 hours after birth Avoided in LBW neonates till they reach 2500g weight Sponging is good enough to clean the baby Cot nursing in hospital (mother sick ): - adequately clothe the baby (including head, extremities) - monitor baby temperature frequently at least 3 hourly during the initial postnatal days

14. Temperature maintenance during transport : Let baby`s temperature stabilise before transport Cary the baby close to chest of mother Cover head, legs and hands

15. HYPOTHERMIA : CLINICAL FEATURES : Peripheral vasoconstriction – Cool extremities Decreased peripheral perfusion CNS depression Lethargy Bradycardia Poor feeding Increased metabolism Hypoglycemia Hypoxia Metabolic acidosis Chronic signs Weight loss

16. Management of hypothermia: Confirm the diagnosis of hypothermia by recording actual body temperature Rewarmed as quickly as possible Choices includes : - skin – to – skin contact A warm room or bed A 200 watt bulb A radiant heater or an incubator

17. Moderate hypothermia : Skin – to – skin contact (warm room and warm bed ) Monitor temperature every 15 – 30minutes Convection warmed incubators Radiant warmers

18. Severe hypothermia Use air – heated incubator Once temperature reaches 34 degree rewarming process should down Start 10 % dextrose, IV Vit. K and provide oxygen