Hypothermia in Neonates:

Prevention of Hypothermia

To prevent neonatal hypothermia, the labor room should be maintained at an ambient temperature of at least 25°C, ensuring no drafts of air by keeping windows and doors closed. A temperature range of 25-28°C for 10-20 minutes is ideal.

Immediately after birth, the newborn should be dried thoroughly, placed in skin-to-skin contact on the mother's abdomen, and covered with warm, dry linen while discarding wet towels. The baby should be capped and dressed appropriately1.

Kangaroo Mother Care (KMC) effectively maintains warmth, especially for low birth weight (LBW) infants2. Frequent breastfeeding is essential to provide adequate energy to sustain body temperature3.

To minimize heat loss, bathing and weighing should be postponed. In term neonates, sponge baths may be given after 24 hours in summer, whereas in winter or in sick/LBW infants, bathing should be delayed until the umbilical cord falls off, typically by the end of the first week1. Dressing in multiple layers of warm, light clothing provides better insulation than a single heavy Woolen layer4.

The mother and baby should remain together in the same bed (co-bedding/rooming-in) to ensure warmth5. Warm transportation is a critical aspect, as neonates are particularly susceptible to severe and unnoticed cold stress3.

Healthcare providers must be trained to recognize, prevent, and manage hypothermia effectively2.

Use of Incubators and Radiant Warmers:

For sick and preterm neonates, incubators and radiant warmers help maintain an optimal body temperature3.

• Incubators are enclosed transparent acrylic cabins with circulating warm air and servo-control systems that adjust heat output based on the infant’s temperature4.

• Radiant warmers are open systems where the neonate lies on a crib with an overhead radiant heat source. A skin probe sensor modulates heater output to maintain a temperature of 36.5°C-37°C5.

Signs and Symptoms of Hypothermia

Hypothermia leads to peripheral vasoconstriction, causing acrocyanosis, cool extremities, and delayed capillary refill time (CRT). The baby may initially be restless, later progressing to lethargy. Chronic episodes of hypothermia result in poor weight gain2.

Severe cases may present with cardiovascular distress, including bradycardia, hypotension, raised pulmonary artery pressure, hypoxemia, and tachypnea3. Neurological manifestations include poor reflexes, decreased feeding ability, and apnea4. Gastrointestinal complications such as vomiting, feeding intolerance, and abdominal distension are common5. If left untreated, severe hypothermia may lead to acidosis, hypoglycemia, oliguria, azotemia, and generalized bleeding1.

Management of Hypothermia

Cold Stress or Moderate Hypothermia

• Remove the baby from cold environments (cold clothes, cold air, wet clothing).

• Initiate skin-to-skin contact or dress the baby in warm layers and place them in a warm room.

• If necessary, use a radiant warmer or incubator.

• Monitor temperature frequently to ensure adequate heating. If hypothermia persists, consider sepsis as a cause3.

• Ensure frequent feeding to prevent hypoglycemia5.

Severe Hypothermia

• Remove all wet clothing and place the neonate in a preheated incubator (35-36°C), radiant warmer, or heated mattress (37-38°C) 4.

• Once the temperature reaches 34°C, slow down the rewarming process to prevent complications3.

• Measure temperature hourly for the first 3 hours; if the rise is 0.5°C per hour, continue monitoring every 2 hours until normal body temperature is reached, followed by 3-hourly checks for 12 hours1.

• If temperature does not rise adequately, reassess heating methods.

• Provide oxygen support, intravenous antibiotics, saline bolus (if shock is present), IV dextrose, and vitamin K as required5.

References

1. Ghai OP. Essential Paediatrics. 10th ed. New Delhi: CBS Publishers; 2022.

2. Hockenberry MJ, Wilson D. Wong’s Essentials of Paediatric Nursing. 11th ed. St. Louis: Elsevier; 2021.

3. Kashimura H, Nakahara A, Fukutomi H. Hirschsprung’s disease, neuronal intestinal dysplasia, hypoganglionosis. Nihon Rinsho. 1994 Dec;Suppl 6:35-7. PMID: 7837495.

4. Roy S, Mathur A, Pati AB. Conventional and emerging technologies for combating Hirschsprung’s disease: The scope of electroanalytical sensing modalities. Sensors International. 2022;3:100184. doi: 10.1016/j.sintl.2022.100184.

5. Mc CR, Ms FC, Piñera JG, Gutiérrez-Junquera C, Jm PF. Neurocrestopatías: Alta frecuencia de disgenesias cerebrales en pacientes con enfermedad de Hirschsprung. Rev Neurol. 2007;45(12). doi: 10.33588/rn.4512.2007256.

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