Speaking of skin to skin.
And I mentioned the importance of skin to skin
as a way to help the infant maintain temperature.
So let's talk about all the ways
and all the things that can happen
that may cause the baby to not
be able to maintain temperature.
So there are four ways that
babies can actually lose heat.
And it's important for the nurses to be aware,
because these are things that we can do that
actually cause the baby to be hypothermic,
or the parents may cause the baby to
be hypothermic if they don't pay attention.
So the first way that the baby
can lose heat is called convection.
So if you think about it this way, maybe you've heard of a convection
or maybe you have a microwave
somewhere in your existence.
And what happens in that situation
is that the air around the food is warm.
And so then it warms up your food, right?
So with the baby, if the baby is
the warm object, and the air is cold,
all that warmth from the baby will be transferred
into the cold air and the baby will lose heat.
So that is via convection.
Now let's talk about radiation
- losing heart via radiation.
So in this particular situation, the baby
might be sitting next to a window that's outside
and the sun is shining, and they
will then lose their heat to the air.
but in this case, it's not the droplets in the air,
it's the electromagnetic waves in the air.
So they're not touching an object and the
heat is being transferred from baby to the air
via the electromagnetic waves.
The next way that we can lose heat
is by actually touching something cold.
So when you go to the nursery
for your clinical experience,
you may notice that before the baby is laying
on any type of scale or any type of surface,
they will either warm the
surface or place a blanket there.
And that's because if the surface
is cold, the heat from the baby
will then be transferred to that surface.
So the difference between conduction
and radiation has to do with touching.
In radiation, the baby's
not touching the cold object.
In conduction, the baby and
the cold object are together.
And then finally, evaporation.
Remember under skin to skin,
we talked about drying the baby off
just like you dry off when
you get out of the shower.
You do that because if you don't, then as
the water evaporates, it takes away your heat.
And so that's the same thing that happens.
So if you ever watched the stork team
working on a baby after they deliver,
they will dry and get rid of those
blankets, because all of those wet blankets
are ways that the baby can lose heat.
So we want to dry the baby
off so that they don't lose heat.
And we want to get the wet
blankets as far away as possible.
So these are the mechanisms of thermal
regulation that we have to be mindful of
and remind the parents of because
the baby doesn't really shiver.
They don't really manage heat loss at all.
They don't have that ability yet, so we
have to make sure that we protect them.
And our final assessment that we're going
to talk about in terms of things that we do
in the labor suite is
monitoring the baby's glucose.
Now, for the healthy term infant that
has an uneventful pregnancy and birth,
then we're only going to
monitor the baby's blood glucose
in the case where we notice risk factors or
in the case when the baby is symptomatic.
So if the baby's doing well, we
may not get a glucose right away.
So keep that in mind.
If however, something pops up, and
they're symptoms that make us believe,
and we'll talk about those in just a
second that the glucose might be low.
If the glucose is less than 45, an
intervention is going to be required.
So infants at risk.
So these are going to be babies
that are large for gestational age,
or babies that are born from birthing
persons who have had gestational diabetes.
Those babies are going to require
close monitoring for 2 to 3 hours after birth,
or until they are stable.
If their blood sugar is less than 35, then
again, intervention is going to be required.
So thinking about symptoms of
hypoglycemia, or low blood sugar.
So these are all the alarm bells that
are going to go off for the nurse care team
and the health care providers
that something is amiss.
If the baby is irritable.
Now, the baby's not going to say
bad things or be smart, obviously,
but they'll be really jumpy and
jittery and just fussy and unusually so.
That may be an indication of low blood sugar.
They may also have just general jitteriness,
where they're shaking sort of like this,
especially with their hands.
That's not Moro.
So moro should elicit and stop.
If it continues then that may be a sign of
jitteriness, which goes along with hypoglycemia.
They may also experience
a high pitched cry, or pallor
meaning that their color is
not pink, like it should be, or full.
It will be a little sort of grayish and off.
They may begin to sweat or
they may experience lethargy.
Or they may not eat very well, or in really terrible
cases where the blood sugar is extremely low,
the baby may experience a seizure
or have respiratory depression.