1
Fifth stage
Pediatric
Lec. 8
.د
رياض
14/12/2016
Neonatal hypothermia
cold stress
Definition & pathophysiology
Is a core temperature <35-35.5C. Rectal temp.
May be mild 35-32 C or severe <32C.
Neonates are prone to hypothermia because of large surface area relative to the body
size and is more risk in premature and low birth wt neonates. Loss of heat may be by
radiation to cooler surrounding objects or by evaporation of water from skin, or by
conduction when skin come in touch with cooler objects or by convection when cool air
take the heat from the skin .
response to heat loss is by vasoconstriction of skin and other tissues and by
nonshivering thermogenesis by using the brown fat to generate calorie and heat.
Brown fat is present arround the kidneys ,adrenals and neck, between the scapula and
in the mediastinum. when it used no replacement for it so it will finish when used and
it is present till 6 month.it is mainly deposited during the 3
rd
trimester.so premature
are with less brown fat.
Hypothermia leads to hypoglycemia, metabolic acidosis, loss of glycogen.
Aetiology
1. Delay wrapping in cold environment at birth.
2. prolonged resuscitation in cold delivery room.
3. exposed body to cold bed or room after birth.
4. Sepsis.
5. Intracranial hemorrhage.
2
Clinical features cold injury
Hypothermia cause depression in all activities of body organs leading cold skin, to poor
feeding, lethargy, poor cry, bradycardia, arrhythmia, respiratory distress due to
vasoconstriction and low surfactant formation, cyanosis, skin mottling, prone to sepsis,
even coma and death.
Treatment
In the hospital; gradual Rewarming by putting under warmer or in incubator with
gradual increase in body temp. goes with the gradual increase in incubator temp.
Treat underlying causes like sepsis or intracranial bleeding.
Prevention
Prevention is by;
Rapid Wrapping the baby to remove the moist from skin at birth to let the skin dry,
and resuscitation in trolley under warmer to prevent loss of heat at birth.
At home in cold season the infant should be wrapped and not exposed to cold.