PowerPoint Presentation The… · PPT file · Web view · 2008-06-08Thermoregulation Sequence Alerting Signs Hypothermia All newborns are at risk for temperature instability Babies

Nov 2007Nov 2007 ACoRN © 2005-07ACoRN © 2005-07

Thermoregulation Thermoregulation SequenceSequence


5Problem List

8Support

Respiratory

Surgical Conditions

Thermoregulation

Fluid & Glucose Management

Neurology

Cardiovascular

1Baby at-

risk

Sequences

2 Resuscitation

3PrimarySurvey

4Infection

Consider transport

6

7


Maintain thermally controlled environment

History & physical examination, if not already done Check temperature q15 to 30 minutes until stable

Normothermia T 36.3 to 37.2ºC axillary

No

Hypothermia T < 36.3ºC axillary

Undress baby Remove extra blankets Decrease incubator/ radiant warmer skin or air temperature setting by 0.5ºC q15 minutes

Thermoregulation T < 36.3 or > 37.2ºC axillary* Increased risk for temperature instability

Thermoregulation Sequence

Yes

YesNo

Yes

No

T < 36.3ºC axillary

Term/near-term well baby

Position baby skin-to- skin with mother Provide warm blanket and hat Recheck temperature

Hyperthermia T > 37.2ºC axillary

Place in pre-warmed incubator OR Place on radiant warmer with servocontrol probe set to 36.5ºC

Ensure the baby is in an environment where temperature can be controlled

Problem ListA A lerting signslerting signs

CC ore stepsore stepsOO rganization of rganization of carecare

RR esponseesponseN N ext ext stepssteps

Thermoregulation Thermoregulation SequenceSequence

SS pecific pecific managementmanagement


Alerting SignsAlerting Signs


HypothermiaHypothermia

• All newborns are at risk for temperature instabilityAll newborns are at risk for temperature instability• Babies at increased risk for Babies at increased risk for hypothermiahypothermia include: include:

– unwell unwell – preterm, especially LBW (<2000g) and VLBW preterm, especially LBW (<2000g) and VLBW

(<1500g)(<1500g)– SGASGA– open lesionsopen lesions– ambient temperature is < 23ambient temperature is < 23ooC or air drafts exist C or air drafts exist – being cared for by us!being cared for by us!


HypothermiaHypothermia

Cold stress can cause:Cold stress can cause:• irritable (initially) / lethargicirritable (initially) / lethargic• pale, mottledpale, mottled• metabolic acidosismetabolic acidosis• hypoglycemia / hyperglycemiahypoglycemia / hyperglycemia• respiratory distress, apnea, tachypnea respiratory distress, apnea, tachypnea • bradycardia / tachycardiabradycardia / tachycardia• vasoconstriction, hypoxia, shockvasoconstriction, hypoxia, shock


HyperthermiaHyperthermia

• Causes include:Causes include:– iatrogeniciatrogenic – maternal epiduralmaternal epidural – maternal hyperthermia maternal hyperthermia – infectioninfection– CNS disordersCNS disorders– administration of PgEadministration of PgE11

• Babies with intrapartum or neonatal hyperthermia Babies with intrapartum or neonatal hyperthermia are at increased risk of neurodevelopmental are at increased risk of neurodevelopmental complicationscomplications


Core StepsCore Steps

Ensure the baby is in an environment where temperature can be controlled


Organization of Care and ResponseOrganization of Care and Response


Specific ManagementSpecific Management


Choosing initial incubator temperature in first 12 hours of ageChoosing initial incubator temperature in first 12 hours of ageBirth weight Birth weight

(grams)(grams)Air temperature setting Air temperature setting ooCC

(double wall, humidified incubator)(double wall, humidified incubator)

< 750< 750 39.5 (37.5)39.5 (37.5)750 to 1000750 to 1000 39.0 (37.0)39.0 (37.0)

1000 to 12001000 to 1200 37.537.51200 to 15001200 to 1500 36.536.51500 to 20001500 to 2000 35.535.5

> 2000> 2000 3434Adapted from: Jaimovich DG, Vidyasagar D. Handbook Pediatric and Neonatal Transport Medicine (2d Adapted from: Jaimovich DG, Vidyasagar D. Handbook Pediatric and Neonatal Transport Medicine (2d Edition). Philadelphia: Hanley & Belfus, Inc. 2002, p. 483 Edition). Philadelphia: Hanley & Belfus, Inc. 2002, p. 483

Initial incubator temperatureInitial incubator temperature


Heat lossHeat loss


Heat loss preventionHeat loss preventionConductionConduction• Pre-warm beddingPre-warm bedding• Cover weigh scale Cover weigh scale • Change wet bedding as Change wet bedding as

soon as possible soon as possible (eg oxyhoods)(eg oxyhoods)

EvaporationEvaporation• Use medium to high Use medium to high

humidity in incubatorshumidity in incubators• Place baby < 29 weeks Place baby < 29 weeks

gestation in plastic baggestation in plastic bag

ConvectionConvection• Ambient temperature ~ Ambient temperature ~

2525ooCC• Avoid air drafts: air vents, Avoid air drafts: air vents,

open/swinging doorsopen/swinging doors

RadiationRadiation• Flexed nested positionFlexed nested position• Double wall incubatorDouble wall incubator


Keeping warmKeeping warm


Questions?Questions?

Documents

PowerPoint Presentation The… · PPT file · Web view · 2008-06-08Thermoregulation Sequence Alerting Signs Hypothermia All newborns are at risk for temperature instability Babies