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Neonatal Hypothermia 2025

Newborns are highly susceptible to hypothermia due to their poor heat regulation, large surface area relative to weight, and limited heat generation mechanisms. Factors such as low subcutaneous fat and increased skin permeability further contribute to their vulnerability. The 'warm chain' strategy is recommended to prevent hypothermia by promoting heat retention and minimizing exposure to cold environments.

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Castillo Piano Composition
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17 views16 pages

Neonatal Hypothermia 2025

Newborns are highly susceptible to hypothermia due to their poor heat regulation, large surface area relative to weight, and limited heat generation mechanisms. Factors such as low subcutaneous fat and increased skin permeability further contribute to their vulnerability. The 'warm chain' strategy is recommended to prevent hypothermia by promoting heat retention and minimizing exposure to cold environments.

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Castillo Piano Composition
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Neonatal Hypothermia

Part-I
Thermal protection of newborn
• Newborn babies are prone to hypothermia as
they have poor heat regulating mechanisms.
• During intrauterine life, the fetal temperature
is 0.5°C higher than the maternal temperature
due to metabolic reactions that generate heat.
• After birth, the infant is exposed to outside
environment which has lower temperature.
Why are Newborns Susceptible to Hypothermia?

• Large surface area of babies compared to their


weight
–The head constitutes a significant portion of the
newborn's surface area and can be a source of
great heat loss
• Limited heat generating mechanisms
• Vulnerability to getting exposed, being
dependent on others for early detection and
rectification
Why are Newborns Susceptible to Hypothermia?

• Additional factors that contribute to heat loss


in LBW babies include:
–Poor insulation due to lower subcutaneous fat
–Decreased brown fat
–More permeable skin
–Larger surface area than term babies
–Poorer physiological response to hypothermia and
early exhaustion of metabolic stores like glucose.
Sources of Heat Loss
i. Radiation to surrounding environment not in
direct contact with baby
ii. Convection to air flowing in surrounding
iii. Conduction to substances in direct contact
with baby
iv. Evaporation of amniotic fluid and moisture
from baby’s skin to atmosphere
Sources of Heat Production
• On exposure to cold and wet environment, the neonate tries
to generate heat by:
– increasing physical activity (crying, increased body movements)
– mounting a sympathetic surge that causes vasoconstriction and
nonshivering thermogenesis in the brown fat
• Brown fat is richly vascularized, sympathetically innervated fat
collections located in the axillae, groin and nape of the neck,
interscapular area and perirenal area.
• Release of norepinephrine uncouples beta-oxidation in fat that
results in heat production.
• Blood passing through brown fat gets heated up to keep baby
warm. Preterm and small for gestational age infants have
scanty brown fat stores.
Response to cold stress in sick neonate
Definitions
• Normal body temperature: 36.5°C to 37.5°C
• Hypothermia: Axillary temperature less than 36.5°C
• Cold stress: 36.0-36.4°C
• Moderate hypothermia: 32-35.9°C
• Severe hypothermia: <32°C
• Hyperthermia: Axillary temperature more than 37.5°C
Definitions
• Thermoneutral environment:
–Thermoneutral zone refers to narrow range of
environmental temperature in which a baby has the
lowest basal metabolic rate and oxygen utilization
and the baby has normal body temperature.
–The thermoneutral zone is different for babies of
different gestation and postnatal age.
Definitions
• Thermoneutral environment:
–Thermoneutral zone is higher for lower gestation
and smaller birth weight; lower for clothed babies
compared to naked ones and is higher in the earlier
hours and days of life than later age.
–This is because preterm, small, naked and younger
neonates need extra warmth to maintain body
temperature.
Measurement of Temperature
• The thermometer for measuring temperature in
neonates should have low reading values till 30°C, so
that degree of severe hypothermia can be accurately
assessed.
• A reasonable idea can be obtained by touching the
baby's hands and feet and abdomen by back of
examiner's hand.
• If everything appears warm, baby has normal
temperature.
• Warm abdomen but cold feet and hands indicate
hypothermia.
• Cold feet and hands as well as the abdomen would
indicate that the baby has severe hypothermia.
Methods of temperature assessment
Frequency of temperature measurement

• Daily for healthy babies who are otherwise


well
• Two to three times daily for healthy small
babies (2 to 2.5 kg)
• Four times daily for very small babies ( <2 kg)
• Every two hour for sick babies
• Mother should be encouraged to assess body
temperature of the neonate by touching the
baby.
Disorders of Body Temperature
• Hypothermia may happen as a result of exposure
to a cold environment such as low ambient
temperature, cold surface, or cold air, or the baby
is wet or not clothed adequately.
• Hyperthermia may result if the infant is exposed
to warm environment such as in summers, direct
sun exposure, or overheating in the incubator or
radiant warmer.
• Hypothermia as well as hyperthermia can also
indicate underlying serious illness.
Warm chain
• The strategy for prevention of hypothermia is
known as warm chain.
• The 'warm chain' is a set of ten steps aimed at:
–decreasing heat loss
–Promoting heat gain
–ensuring that baby is not exposed to the
circumstances that can result in hypothermia
Steps of warm chain
i. Warm delivery room
ii. Warm resuscitation
iii. Immediate drying
iv. Skin to skin contact
v. Breastfeeding
vi. Bathing postponed
vii. Appropriate clothing
viii. Mother and baby together
ix. Professional alertness
x. Warm transportation

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