TODAY -

Hypothermia and its Management in Newborn

Jodibala Haobijam *

Introduction:

The normal newborn continues to adapt to the extra uterine life within the first week after child birth remaining vulnerable to hypothermia. The baby remains dependent on mother for nutrition and protection.

Mother is responsible for maintaining the body temperature of the baby among other functions essential for survival. Due to certain characteristics such little subcutaneous fat, low birth weight babies, exposing the baby to the cold climatic conditions increases risk of hypothermia.

Distribution and incidence

Hypothermia in the newborn occurs throughout the world, often during the cooler seasons, and in regions where there is a large temperature difference between day and night. As similar environmental condition prevails in northeastern regions of India the newborn are at risk of hypothermia.

In a study conducted in Ethiopia, on admission, 67% of low birth weight and high-risk infants admitted to a special care unit were hypothermic. In Nepal, during the winter months, over 80% of the infants born became hypothermic after birth and 50% remained hypothermic at 24 hours.

Many more research evidences are available supporting the role of environmental temperature in the development of hypothermia in newborn.

Hypothermia in newborn

The newborn with a temperature of 36.0-36.4°C (96.8-97.5°F) is under cold stress (mild hypothermia). A baby with a temperature of 32.0-35.9°C (89.6-96.6°F) has moderate hypothermia, while a temperature below 32°C (89.6°F) is considered to be severe hypothermia..

Causes and risk factors

Hypothermia of the newborn is mainly due to lack of knowledge. In many hospitals incorrect care of the baby at birth is the most important factor in causing hypothermia, delivery rooms are not warm enough and the newborn is often left wet and uncovered after delivery.

The newborn is weighed naked and washed soon after birth. The initiation of breast-feeding is frequently delayed for many hours, and the baby is kept in a nursery, apart from the mother. In many newborns these practices will result in hypothermia.

At home, families and Trained Birth Attendants (TBAs) may also not be aware of the importance of drying and wrapping the newborn immediately after birth. Other risk factors include asphyxia, use of anesthetic or analgesic drugs during delivery, infection or other illness of the infant and inadequate measures taken to keep the baby warm before and during transportation.

Signs of hypothermia

An early sign of hypothermia is feet that are cold to the touch. If prolonged leads to hypothermia, the baby becomes less active, suckles poorly, impaired feeding and has a weak cry.

In severely hypothermic babies the face and extremities may develop a bright red colour. The baby becomes lethargic and develops slow, shallow and irregular breathing and a slow heart beat.

Low blood sugar and metabolic acidosis, generalized internal bleeding (especially in the lungs) and respiratory distress may occur. Such a level of hypothermia is very dangerous and unless urgent measures are taken, the baby will die.

Effects of Hypothermia

There is no evidence that hypothermia has any beneficial effect immediately after birth, for example cold stress is not needed at birth, as commonly believed, to initiate or stimulate breathing. Although many traditional practices are beneficial such as heating the delivery room in cold weather, wrapping the baby and keeping it close to the mother.

On the contrary there is sample evidence that hypothermia is harmful. Prolonged hypothermia is linked to impaired growth and may make the newborn more vulnerable to infections, others are harmful such as sprinkling the newborn with cold water to stimulate breathing, bathing the baby soon after birth, delaying breast-feeding in the belief that colostrums is harmful or useless.

Management of hypothermia

Thermal protection of the newborn is the series of measures taken at birth and during the first days of life to ensure that the baby does not become either too cold (hypothermia) and maintains a normal body temperature of 36.5-37.5°C (97.7-99.5°F).

Newborns found to be hypothermic must be rewarmed as soon as possible. It is very important to continue feeding the baby to provide calories and fluid. Breast-feeding should resume as soon as possible.

If the infant is too weak to breast-feed, breast milk can be given by, spoon or cup. It is important to be aware that hypothermia can be a sign of infection. Every hypothermic newborn should therefore be assessed for infection.

Management in Hospital

In hospital a diagnosis of hypothermia is confirmed by measuring the actual body temperature with thermometer.

In cases of mild hypothermia the baby can be rewarmed by skin-to-skin contact, in a warm room (at least 25°C/77°F).

In cases of moderate hypothermia the clothed baby may be rewarmed by the following measures:

  • under a radiant heater;
  • in an incubator, at 35-36°C (95-96.8°F);
  • by using a heated water-filled mattress;
  • in a warm room: the temperature of the room should be 32-34°C/89.6-93.2°F
  • in a warm cot: if it is heated with a hot water bottle, these should be removed before the baby is put in.
  • The rewarming process should be continued until the baby's temperature reaches the normal range.
In cases of severe hypothermia studies suggest that fast rewarming over a few hours is preferable to slow rewarming over several days. Rapid rewarming can be achieved by using a thermostatically-controlled heated mattress set at 37-38°C (98.6-100.4°F) or an air-heated incubator.

The "warm chain" is a set of ten interlinked procedures carried out at birth and during the following hours and days which will minimize the likelihood of hypothermia.
  • The room where the birth occurs must be warm (at least 25°C/77°F) and free from draughts.
  • At birth, the newborn should be immediately dried and covered, before the cord is cut.
  • While it is being dried, it should be on a warm surface such as the mother's chest or abdomen (skin-to-skin contact).
  • If this is not possible, alternative means of preventing heat loss and providing warmth such as wrapping, placing the baby in a warm room or under a radiant heater.
  • Bathing and weighing the baby should be postponed.
Management at home
  • At home, skin-to-skin contact is the best method to rewarm a baby.
  • The room should be warm; the baby should be covered with a warm blanket and be wearing a cap.
  • The mother should continue breast-feeding as normal.
  • If the baby becomes lethargic and refuses to suckle, these are danger signs and it should be taken to hospital
  • While being transported, the baby should be in skin-to-skin contact with the mother during transportation.
PREVENTION OF HYPOTHERMIA
  • Refrain from bathing the newborn immediately post delivery.
  • When bathing a neonate wash and dry only a small area of the body at a time, keeping the rest of the infant's body covered.
  • The baby should be dried well and then wrapped.
  • Avoid unnecessary exposure when attending to baby's needs.
  • The mother should keep the baby close to her body to avoid hypothermia.
  • In general, newborns need a much warmer environment than an adult.




* Jodibala Haobijam writes to e-pao.net for the first time. The writer is a Lecturer in Department of Maternal and Child Health at M M College of Nursing, HARYANA. The writer can be contacted at jodibalahaobijam(at)yahoo(dot)co(dot)in
This article was webcasted on November 24, 2008.


* Comments posted by users in this discussion thread and other parts of this site are opinions of the individuals posting them (whose user ID is displayed alongside) and not the views of e-pao.net. We strongly recommend that users exercise responsibility, sensitivity and caution over language while writing your opinions which will be seen and read by other users. Please read a complete Guideline on using comments on this website.




LATEST IN E-PAO.NET
  • Zeliangrong orphaned by Nationalism #2
  • General Thangal Eco Park : Gallery
  • Letter to President on Crisis at MU
  • Precision medicine & life sciences
  • Black topping-can ground leveling be behind
  • Condemns security force intrusion in MU
  • Developer wanted at LMP, Konjeng Leikai
  • AR gears up for International Yoga Day
  • NPF rejoinder to NDPP : 20 June
  • Rejoinder by Dr. Shurhozelie : 20 June
  • For a little bit more
  • Deadline of 5 days time set : MU crisis
  • Garlic Festival @Ukhrul #4 :: Gallery
  • Flood in Imphal [14 June] #3 : Gallery
  • Inungshi, Gaichanglungliu :: eMing
  • Taking 'Hau' Music to Rest of World
  • Kakching bags cleanest city in NE Award
  • JRF (Junior Research Fellow) at IBSD
  • Oxfam India launches emergency response
  • VC, MU - Resign immediately :: MUTA
  • Inner Line Permit (ILP) Demand :: Timeline
  • Translation of ancient Manipur texts begin
  • Pre Yoga Capsule organized
  • NDPP Rejoinder on 19 June
  • NPF Youth Wing Rejoinder on 19 June
  • Favouring digital govt : still a Virtual dream
  • June 18 Anniv : Consult all stakeholders
  • Great June Uprising @Kekrupat #1 : Gallery
  • Binota Thokchom at BRICS Young Scientist
  • The Merger of Manipur
  • Improving school management in Manipur
  • Pros & cons of screening tests
  • NPF Rejoinder on 18th June
  • Nagaland CM statement on Aboi ambush
  • June 18 significance: Still living on prayer
  • Need to identify one's strength
  • 18 Immortal Souls Remembered : Flash
  • The Great June Uprising : Read all about it
  • The Pitfalls of Identity Politics
  • Naga Peace Process :: News Timeline
  • All his sons :: Poem
  • Citizenship (Amendment) Bill, 2016
  • Eid bring cheer in flood hit areas
  • Willong Khullen, Maram #1 : Gallery
  • Eyek Tamba :: Learn Manipuri script
  • Defending the environmental defenders
  • Delusion in self - cause of worry
  • Road to Russia: FIFA World Cup
  • It must be love :: Poem
  • 'Future of Naga people is bleak'
  • Give a miss call to Amnesty
  • 'Naga area' bandh on June 18
  • Dzuko valley #4 :: 360 Panorama View
  • Flood in Imphal [14 June] #2 : Gallery
  • Id-Ul-Fitr Festival
  • Letter to PM Modi on Naga Talks
  • Greetings on Eid-Ul-Fitr
  • Rejoinder to NPF statement
  • Rejoinder to Nagaland Chief Minister
  • Flood relief continue on 3rd day
  • India-Vietnam Youth Dialogue 2018
  • MU debacle: Why would it be left unnoticed
  • Spirit of World Cup : Brazil to Russia
  • NEC to come under Home Ministry
  • Manipur NGO hosts summit on LGBTQ
  • Flood in Imphal [14 June] #1 : Gallery
  • Women Struggle in Self-Determination
  • 14 June- World Blood Donor Day
  • Naga Integration not possible- NPF react
  • Naga Integration is not possible- CM Rio
  • Relief work in flood affected areas
  • A day which keeps our spirit alive
  • Ranked 320 in the country : MU
  • Flood in Imphal [13 June] #2 : Gallery
  • Sovereignty Struggles in Northeast #5
  • Be alert: It's admission time
  • Yin and Yang
  • Watermelon beauty benefits
  • Temp accommodation for Aligarh students
  • Wrath of Mother Nature: Why challenge..
  • 60 pc is no longer first class : 95 pc
  • Flood in Imphal [13 June] #1 : Gallery
  • Sanamahi Laihui & Sanamahi Laining
  • Kuhi- Essential plant for Nungbi pottery
  • Climate justice is integral to development
  • The bridge :: Poem
  • Lt S Vijaya Devi felicitated
  • Then : Indifferent :: Now : Hyper sensitive
  • Phumdigi Tantha : Dance Drama : Gallery
  • Grief at Xavier Rutsa's demise
  • Modi's India: A descend into Ochlocracy
  • The Philippine Experience
  • Cry of a Dying River #33 :: Poem
  • Community Iftar at Moijing, Cachar
  • Candle Light at DU over Assam lynching
  • Demand replacement of Manipur Univ VC
  • The Tragedy of Higher education
  • Unacceptable points spelt out
  • Teinem Luira Phanit @Ukhrul #3: Gallery
  • RPL-PMKVY trainees @Hojai : Gallery
  • Manipur Sports University in UP ?
  • Coloniality of the Postcolonial
  • Yellow leaves in the autumn :: Poem
  • Prof N Irabanta-distinguished academician
  • Leadership matters
  • Artificial turf for budding talents
  • 2 municipal bodies in NE awarded
  • Who is Arambam Somorendra ?
  • Manglandasu Nang - OST :: e-pao Radio
  • Shirock 2018 - Shirui Lily Fest #3 : Gallery
  • Linthoi's "The Tales of Kanglei Throne" #2
  • Grass root challenge- Education in hills
  • Earth does not belong to us...
  • Sita Mata as test-tube baby
  • What happen to VIP Culture Mr. CM
  • Merchants of education
  • Laitonjam Rajnikanta : Profile
  • A blessing to see :: Poem
  • Sovereignty Struggles in Northeast #4
  • Difference between Hinduism & Hindutva
  • How to choose the perfect fragrance
  • Iftaar party at Lilong
  • Bitter truth of Manipuri society
  • MU, NSU, IGNTU : Students at the centre
  • Amuktang-Ga Haikho #1 : eRang
  • Sangai Veterans' Football #2 : Gallery
  • Pony : A Cavalry Horse Par Excellence #2
  • Issues that keep Manipur burning
  • Cry of a Dying River - 32 :: Poem
  • CM & AR interaction with villagers
  • Certification of PMKVY trainees of Hojai
  • Christian appeals for Peace in Shillong
  • How safe are our women?
  • Riders put up by JAC for talk
  • Khangkhui Cave in Ukhrul #3 : Gallery
  • Pluralism, Democracy & Ethnic Relation #2
  • Irom Sharmila meets with Mehbooba Mufti
  • JRF @ Mizoram University (Biotechnology)
  • Tobacco and heart disease
  • Understanding SOWA - RIGPA #2
  • Campaign "to End Child Sexual Abuse"
  • Implementation of 7th Pay
  • Indigenous street vendor sing gi wafam
  • The crumbling Manipur University
  • Kang Tournament @ Yaiskul : Gallery
  • Zeliangrong orphaned by Nationalism #1
  • A rainy night :: Poem
  • HSLC Exam is the start! What next?
  • 1528 cases of fake encounter
  • Linthoi's "The Tales of Kanglei Throne" #1
  • Handloom Weaver @Bishnupur : Gallery
  • Shirock 2018 - Shirui Lily Fest #2 : Gallery
  • Hinduism in Manipur : Political Perspective
  • All the World and his Wife :: Poem
  • Tribal Cultural Festival #1 : Gallery
  • Women in CCpur turn to self-help groups
  • Purul Paoki Wrestling : Gallery
  • Sangai Veterans' Football #1 : Gallery
  • Khangminashi IV (Lecture) : Report
  • Seminar at MU - Hinduism in Manipur'
  • Evolution of The Meetei State
  • Heartbreak at Ukhrul: Unfolding Shirock
  • State Level Khurpui-Lam Festival: Gallery
  • June Calendar for Year 2018 :: Tools
  • School Girls Basketball #2 : Gallery
  • Where is Manipur....???
  • 'Manipur' in Google maps : Gallery
  • The Killing Fields - 2013-18 : News Timeline
  • Mama Poktabi :: Funga Wari
  • Veterans Football Tournament #2 : Gallery
  • Shirock 2018 - Shirui Lily Fest #1 : Gallery
  • Sougrakpam Vijaya makes history sailing...
  • Arunachali unfurled Salai Taret at Mt Everest
  • Panthoiba: 2nd Rank- class XII, Uttarkhand
  • Ras Leela @JNMDA Day : Gallery
  • HSLC 208 Exam Toppers : Gallery
  • HSLC 2018 :: Toppers Listing
  • HSLC 2018 :: Check Result
  • HSLC :: Statistical/Subject Topper
  • HSLC 2018 :: External
  • Poumai Purul Hiimai Paoki #2 : Gallery
  • Kakching Garden :: 360 Panorama View
  • Folk Dance Festival #5 : Gallery
  • Aerial view from Chingmeirong : Gallery
  • Curtain Raising- Sangai Fest 2017: Gallery
  • Lainingthou Lai Lam thopka #2 : Gallery
  • Re-visiting Khangkhui caves in Ukhrul
  • Gardening @Ema Keithel #2: Gallery
  • Front Page Photo 2018 #2: Gallery
  • Pakhangba Cheng Hongba #2 : Gallery
  • Steelheart @ Shirock , Ukhrul #3 : Gallery
  • A. Halim Chowdhury: A Profile
  • Class XII Exam Toppers : Gallery
  • Class XII Result : Science Toppers
  • Class XII Result : Arts Toppers
  • Class XII Result : Commerce Toppers
  • HSE Result 2018 : District Wise
  • HSE Result 2018 : Highest Marks
  • HSE Result 2018 : Science Stream
  • HSE Result 2018 : Arts Stream
  • HSE Result 2018 : Commerce Stream
  • Temples of Manipur : Gallery
  • Recipients of Akademi Awards for 2014
  • Old Manipuri Movie #1 :: eRang Classic
  • SPONSORED ADS