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Hypothermia is
defined as a core temperature below 36°C. The healthy
baby tries to maintain his temperature within the normal
range and continues to adapt to the extra uterine life
within the first week after birth. Thermoregulation in
a newborn is easily disturbed because their neurological
systems are not fully developed at birth. Certain characteristics
such as low subcutaneous fat, exposure of baby to cold
and low birth weight increase the risk of hypothermia.
Hypothermia in newborn is a world wide problem especially
during cold weather and in countries where marked difference
between day and night temperature are observed. A study
conducted in Nepal revealed that during the winter months
over 80 percent of the infants born become hypothermic
after birth and 50 percent remained hypothermic at 24
hours. Many more research evidences are available to support
the role of environmental temperature in the development
of hypothermia.
Hypothermia in newborn is classified as ‘mild’ or under
cold stress when its temperature at birth is 36.0 – 36.4°C
(96.8-97.5°F), ‘moderate’ 36.0 – 36.1°C (96.8- 97.5°F)
and ‘severe’ when it is below 32°C (89.6°F).
The authors are : Principal and Vice- Principal respectively
at Gian Sagar College of Nursing, Village Ram Nagar, Banur,
Distt. Patiala, Punjab |
Risk Factor and Causes
Hypothermia in newborn is due to certain factors such
as variation in intrauterine temperature and birthing
room temperature, evaporation of amniotic fluid from
the baby’s skin, thin subcutaneous fat layer, limited
ability of newborn to shiver which helps to generate
heat, immaturity of hypothalamus, heat loss by conduction,
convection, evaporation and radiation. Other risk factors
include asphyxia, use of anaesthetic or analgesic drugs,
infection or other illness of baby and inadequate measure
taken to keep baby warm before and during transportation.
In hospitals, common reasons of hypothermia include:
incorrect care of baby at birth, delivery room temperature
cool, improper wrapping of baby after birth and leaving
wet. In domiciliary deliveries, the causative factors
are: lack of knowledge among families and traditional
birth attendants regarding the importance of drying
and wrapping of newborn immediately after birth.
Clinical Manifestations
In early signs baby look pale or mottled, cold to touch,
less active, not taking feed and has a weak cry.
In later or severely hypothermic babies, sclerma, a
hardening of the skin associated with reddening and
oedema may occur on the back and limbs or over the whole
body. The baby becomes lethargic |
and develops slow, shallow and irregular breathing,
slow heart beat, low blood sugar, metabolic acidosis,
generalised bleeding and respiratory distress. Mortality
rate is increased if proper measures are not adopted
during birth or after birth.
Prolonged hypothermia may cause impaired growth and
make the newborn more vulnerable to infection, increase
the incidence of respiratory distress, metabolic acidosis,
jaundice and death of neonates regardless of weight
and gestational age.
Role of Community Health Nurse in Prevention
& Management of Hypothermia:
A majority of Indian population is living in rural area,
where the neonatal health services are poor and disorganised.
The National Rural Health Mission (NRHM) in India has
set the objective of reducing infant mortality rate
(IMR) to 30 per 1000 live birth by 2020.
Achieving this objective will require a reduction in
newborn death of over 50 percent in less than a decade.
There is need to have a massive health initiative to
train paramedical personnel particularly trained birth
attendants, ASHA, FMPW in antenatal care, safe delivery,
neonatal resuscitation, provision of asepsis, warmth
and adequate feeding.
The main components of essential newborn care like prevention
of hypothermia and sepsis, neonatal resuscitation, exclusive
breast feed- |
ing, Kangaroo Mother Care
and vaccination should not
only form the cornerstone of
training of health workers at
grassroot level but also needs
to be popularised at the community
level through innovative
schemes. Special training
workshops for periphery
level health workers are
organised by Community
Health Nurses to teach essential
newborn care interventions.
In Community Health Services,
Midwifery services
should be a priority. A trained
newborn care provider is essential
at child birth in home
deliveries. A nurse must have
knowledge of baby’s transitional
requirements. Provision
of an optimal thermal environment
is paramant in facilitating.
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a successful transition
to extra uterine life. The
baby’s temperature can drop
by as much as 3-4.5°C within
the first minute. So a nurse
first needs to assess the environment
of delivery setting. It
should be safe and warm place
for delivery. Other tips include:
 Switch off all the fans.
Close curtains to reduce
heat loss.
Dry the baby after birth.
Remove wet towel. After
drying wrap the baby in a
dried or pre-warmed towel
or in logger as done in Indian
villages.
Skin to skin contact with
mother is essential.
Bathing and weighing of
baby should be postponed.
The Mother should continue
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breast feeding.
Avoid unnecessary exposure
while caring baby.
Teaching the parents the
need to prevent chilling.
Wetness in the child’s environment
to be removed.
In case of deterioration in
child’s health, transfer the
baby to hospital under safe
environment.
References
1. Diave M Frasher (2003). Textbook
for Midwives, Churchill Livingstone,
Edinburgh, Toronto, 14th edn
2. Park K (2007). Textbook of Preventive
and Social Medicine, 19th
edn, Jabalpur
3. http:/www.who.int/reproductive -
health / publications/MSM 972
Thermal protections
4. http:/www.e-pao.net/ep subpage
extractor, asp? Src = education,
Health Issue Hypothermia.
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