THERMO REGULATION HYPOTHERMIA

ALI USMAN
PERINATOLOGY SUBDIVISION CHILD HEALTH DEPARTEMENT PADJADJARAN UNIVERSITY

I. BACK GROUND
NEONATAL HYPOTHERMIA IS MAYOR PROBLEM DURING NEONATAL PERIODE: HIGH MORBIDITY AND MORTALITY MEDICAL STAFF SHOULD BE CONCERN (WHAT-WHY-HOW TO MANAGE OF NEONATAL HYPOTHERMIA) HYPOTHERMIA IS A RISK FOR NEWBORN: IN ANY CLIMATE, WHETER INTROPICS OR IN COOL MOUNTAINE AREA

II. DEFINITION
OPTIMUM BODY TEMPERATURE : 36,50-37,50 C COLD STRESS : 360-36,40 C MODERATE HYPOTHERMIA : 320-35,90 C SEVERE HYPOTHERMIA : < 320 C

III. ETIOLOGY
1. INCORRECT CARE OF THE BABY IMMEDIATELY AFTER BIRTH : A. TOO FAST BATHING OF THE BABY B. DELAY DRYING AND COVERING OF THE BABY C. SEPARATION OF MOTHER FROM BABY AFTER BIRTH 2. TEMPERATURE OF DELIVERY ROOM AND BABY ROOM LOW

3. 4. 5. 6. 7. 8. 9.

PRETERM (LBWI) PERINATAL ASPHYXIA SISTEMIC INFECTION BIRTH INJURY CONGENITAL ANOMALY (CHD) MOTHER GET ANAESTHETIC DRUGS INADEQUATE WARMING PROCEDURES BEFORE AND DURING TRANPORT OF INFANT

IV. EPIDEMIOLOGY
NEONATAL COLD INJURY OCCURS THROGHOUT THE WARD. ETHIOPIA : 67% LBWI & HIGH RISK INFANT IN HCU/NICU HYPOTHERMIA NEPAL : 80% LBWI HYPOTHERMIA, 50% STILL HYPOTHERMIA DURING 24 HOURS INDIA : NEONATAL HYPOTHERMIA DEATH 2 TIMES THAN HEALTHY BABIES ENGLAND : ALL BABY REFFER TO HOPITAL MORBIDITY & MORTALITY INDONESIA: LBWI , MORBIDITY OF HYPOTHERMIA .

V. PATHOPHYSIOLOGY A. HEAT SOURCES OF PRODUCTION B. PROBLEM OF NEONATE

1. NEONATE COMPARE OLD BABY 2. AT LBWI/PRETERM BABY

C. THE PROCESS OF HEAT LOSS D. THE EFFECT OF COLD STRESS

1. PHYSIOLIGIC RESPOND 2. PATHOLOGIC RESPOND - FAST / ACUTE REACTION - CHRONIC REACTION

VI. CLINICAL MANIFESTATION

1. COLD STRESS - BODY TEMPERATURE 360-36,40 C - LEGS FEEL COLD - LETHARGY - LESS ACTIVITY - WEEK CRYING - SUCKING ABILITY WEAK

2. HYPOTHERMIA :
A. MODERATE HYPOTHERMIA BODY TEMPERATURE 32-35,90 C SOMNOLENT LOWER ACTIVITY AND CRYING PETECHIE, PURPURE LEGS FEEL COLD WEAKEN SUCKING

A. SEVERE HYPOTHERMIA
BODY TEMPERATURE < 320 C SOMNOLENT CRYING / SKIN HARD AND RED COLOUR WHOLE BODY COLD SCLEREMA NO BREAST FEED FATAL COMPLICATION

VII. BIOCHEMICAL RESPOND

HYPOGLYCEMIA INCREASE CATABOLISM ELEVATE BUN INCREASE OXYGEN UTILIZATION DECREASE pH and PaO2 THROMBOCYTOPENIA INCREASE OF CALORY UTILIZATION

FATAL COMPLICATION :
SYSTEMIC INFECTION RENAL FAILURE APNEA ATTACK INTRACRANIAL BLEEDING INTRA PULMONAL BLEEDING

VIII. DIAGNOSTIC OF HYPOTHERMIA

DEFINITION HYPOTHERMIA (WHO, 1993) CLINICAL FINDING BIOCHEMICAL RESPOND

IX. MEASURING OF HYPOTHERMIA

RESPECT MEASUREMENT OF BODY TEMPERATURE IS IMPORTANT IN THE ASSESING AN INFANTS HEAT BALANCE SLOW READING THERMOMETER SHOULD BE USED FOR ALL MEASUREMENT : A. AXILLARY TEMPERATURE B. RECTAL TEMPERATURE C. SUBLINGUAL TEMPERATURE (NOT RECOMMENDED)

X. FREQUENCY OF MEASUREMENT
MINIMUM SCHEDULE: IMMEDIATELY AFTER COMPLETENCE OF INIATED CARE UPON ARRIVAL IN THE NURSERY OR POST NATAL WARD HEALTHY BABIES WITH ROOMING IN : NO FURTHER ROUTINE MEASUREMENT EXCEPT THE BABYS FEET FEEL COLD SICK/HIGH RISK BABIES: MOREFREQUENT INFANT UNDER RADIANT HEATER : EVERY 30 MINUTE

XI. MANAGEMENT OF HYPOTHRMIA

A. TO PREVENT HYPOTHERMIA : 6 WARMS CLEAM

B. TREATMENT OF HYPOTHERMIA : 1. IN THE HOME 2. IN THE PRIMARY HEALTH CARE 3. IN THE HOPITAL