HIPOTHERMIA

Perinatology Division
Dept. of Child Health Medical School
University of Sumatera Utara
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HIPOTHERMIA
Significant problem in neonates at
birth and even at 24 hours of age and
beyond
Mortality rate twice in hypothermic
babies
contributes to significant morbidity & mortality
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Why are newborns prone to

develop hypothermia
Larger surface area per unit body weight
Decreased thermal insulation due to lack of
subcutaneous fat
Reduced amount of brown fat (LBW infant)

Non - shivering thermogenesis

Heat is produced by increasing metabolism,
especially in brown adipose tissue
Blood is warmed as it passes through the
brown fat, and it in turn warms the body

FOUR WAYS A NEWBORN MAY LOSE HEAT TO

THE ENVIRONMENT
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HEAT LOSS.
CONDUCTION

Transfer of body heat

to skin surface.

CONVECTION
EVAPORATION
RADIATION

Dry and wrap the

baby Place in a warm
mattress
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HEAT LOSS
CONDUCTION
CONVECTION
EVAPORATION

Skin heat loss depends

on air temperature/flow.

RADIATION

Wrap the baby and

control room
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temperature

HEAT LOSS.
CONDUCTION
CONVECTION
EVAPORATION
RADIATION

Depend upon air

humidity

Control humidity
and room
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temperature

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HEAT LOSS
CONDUCTION
CONVECTION
EVAPORATION
RADIATION

The transfer of body heat

to environmental
temperature

Radiant heater and

control room
12
temperature

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Warm chain
Warm delivery room (>25C)

Bathing postponed

Warm resuscitation

Appropiate clothing

Immediate drying

Mother & baby together

Skin-to skin contact

Warm transportation

Breastfeeding

Professional alert

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Axillary temperature in the

newborn ( 0C)
Normal range

Cold stress
Moderate hypothermia

Severe hypothermia

37.5o

36.5o

Cause for concern

36.0o

Danger, warm baby

32.0o

Outlook grave, skilled

care urgently needed

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Temperature recording
Axillary temperature recording for 3 minutes is
recommended for routine monitoring
Dont record rectal temperature in all babies
as a standard protocol
Record rectal temperature in a sick
hypothermic neonate

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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

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Prevention of hypothermia at birth

Delivery in warm room

Dont bathe immediately after birth
Dry baby immediately with warm clean towel
Wrap baby in pre-warmed cloth, cover head
Keep next to mother

KMC = Kangaroo Mother Care

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Signs and symptoms of

hypothermia
Peripheral vasoconstriction
-

acrocyanosis, cold extremities

decreased peripheral perfusion

CNS depression
-

lethargy, bradycardia, apnea, poor

feeding
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Signs and symptoms (cont..)

Increased pulmonary artery pressure
- respiratory distress, tachypnea
Chronic signs
- weight loss, failure to thrive

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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 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(32.0C to 35.9C )
Skin to skin contact
Warm room/bed
Take measures to reduce heat loss
Provide extra heat
- Heater, warmer, incubator
- Apply warm towels

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Infant Warmer

Incubator

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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 still hypothermic, consider antibiotics assuming
sepsis
Monitor HR, BP, Glucose (if available)

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Kangaroo
Mother
Care

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What is KMC

A special way of caring for Low birth weight

(LBW) babies
It promotes

Effective thermal control

Breast feeding

Prevention of infection

Parental bonding

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Components of KMC

Skin-to-skin contact
Early, continuous and
prolonged skin-toskin contact

Exclusive breast feeding

Promotes lactation and
facilitates feeding

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Benefits of KMC

Breast feeding

Increased breast feeding rates

Increased duration of breast

feeding

Thermal control

Effective thermal control

Equivalent to conventional
incubator care
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Benefits of KMC (cont..)

Early discharge
Better weight gainEarly discharge

Lesser morbidity
Regular breathing
Decreased episodes of apnea
Protection from nosocomial infections

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Benefits of KMC (cont..)

Other benefits

Less stress to the infant

Stronger bonding

Deep satisfaction for mother

More confident parents

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Requirements for KMC

implementation

Training
Nurses, physicians and other staff

Educational material
Information sheets, posters and video films on
KMC

Furniture
Semi-reclining easy chairs
Beds with adjustable back rest
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Eligibility criteria: Baby

Birth weight >1800 gm:

Start at birth

Birth weight 1200-1799 gm:

Hemodynamically stable

Birth weight <1200 gm:

Hemodynamically stable
Hemodynamic stability is a MUST
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Eligibility criteria: Mother

Willingness
General

health & nutrition

Hygiene
Supportive

family
Supportive community

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Preparing for KMC

Counseling

Mothers clothing

Demonstrate procedure
Ensure family support
KMC support group
Front-open, light dress as per the local culture

Babys clothing

Cap, socks, nappy and front-open sleeveless

shirt
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KMC procedure:
Kangaroo positioning

Place baby between the mothers breasts in

an upright position
Head turned to one side and slightly extended
Hips flexed and abducted in a frog position;
arms flexed
Babys abdomen at mothers epigastrium
Support babys bottom

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KMC procedure:
Kangaroo positioning (cont..)

Baby between
mothers breasts

Support babys
bottom

Head turned
to one side
Frog-leg
position

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Monitoring during KMC

Check if
Neck position is neutral
Airway is clear
Breathing is regular
Color is pink
Temperature is being maintained
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Initiation of KMC
Baby should be stable
Short KMC sessions can be initiated
even if the baby is receiving

IV fluids

Oxygen therapy

Orogastric tube feeding

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Duration of Kangaroo Mother

Care
Start KMC sessions in the nursery
Practice one hour sessions initially
Transit from conventional care to longer
KMC
Transfer baby to post-natal ward and
continue KMC
Increase duration up to 24 hours a day

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KMC during sleep and resting

Resting
Reclining or semi-recumbent position
Adjustable bed
Several pillows on an ordinary bed
Easy reclining chair

Sleep

Supporting garment restraint for baby

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Father & other family members can

also provide skin-to-skin care

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KMC during sleep

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Discharge criteria
Baby is well with no evidence of infection
Feeding well (predominant breast milk)
Gaining weight (15-20 gm/kg/day)
Maintaining body temperature (in room
temperature)
Mother confident of taking care of the baby
Follow-up visits ensured

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Discontinuation of KMC
Term gestation
Weight ~ 2500 gm
Baby uncomfortable

Wriggling out
Pulls limbs out
Cries and fusses

Mother can continue KMC after giving the baby

a bath and during cold nights
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