A PRESENTATION ON HYPOTHERMIA

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Introduction
Hypothermia is a condition in which the internal temperature falls to 350 C as a result of exposure to cold. The neonate is prone to develop hypothermia as after delivery baby enters into a much cooler environment contrasts with intra-uterine temperature. The infant's large surface area and thin subcutaneous layer of fat also allow transfer of heat to the environment thus cooling his blood. The pretern baby develops hypothermia due to poor development of heat regulation centre, insulating subcutaneous fat and less brown adipose tissue.

Thermal Balance
new born losses heat by evaporation particularly soon after birth (due to evaporation of amniotic fluid from skin surface) Conduction by coming in contact with cold object, cloth and tray. Convection by air currents in which cold all replaces warm air around baby e.g. windows, fans. Radiation to colder solid object in vicinity wall.

Grading of hypothermia
Normal 36.50 C -37.50C In hypothermia
- <36.50C Moderate 35.90 to 320 Severe <320 C
Mild

Temperature recording
Auxiliary temperature is good and safer. The temperature is read for 3 minutes. Rectal Temperature: Do not use for regular/ routine. reading are taken for 2 minutes but is not a standard one. Skin temperature: it is recorded by thermister. The probe of the thermister is attached to the skin over the abdomen. The thermister senses the skin temperature and displaces it on the panel.

Causes
Cold room (evaporation, radiation, conduction, convection) Decrease fat store Decrease subcutaneous insulation and fine body hair Increased surface area Hypothyroidism Low amount of musculature and inability or reluctance to shiver Inability to move away form clod areas, air currents or heat draining materials. Nervous system is not fully developed so doesn't respond quickly and or properly to cold.

Signs and symptoms

A.

Peripheral vasoconstriction
  

Acrocynosis Cool extremities Decreased peripheral perfusion Lethargy Bradycardia Apnoea Poor feeding

B.

CNS depression
   

Continue
C.

Increase metabolism
        

Hypoglycemia Hypoxia Metabolic acidosis Increase of pulmonary artery pressure Distress Tachypnea Chronic pain Weight loss Poor weight gain

Management of Hypothermia
A hypothermic baby should be warmed as quickly as possible. Warm delivery room(>25c).switch of fan and air condition. Warm resuscitations. Immediate drying, remove wet or cold clothing if present. Warm the baby using skin to skin contact, best technique is kangaroo mother care(keep the baby in mother's chest) Avoid contact with cold surfaces e.g. weighing Appropriate clothing and bedding(cover baby's head) Warm transportation Breast feed frequently Train and aware healthcare providers.

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