00:01
The next newborn complication
we'll discuss is hypothermia.
00:05
So who is at risk for hypothermia?
Well, all newborns are at risk.
00:11
Specially premature infants.
00:12
So when we think about the skin,
we think about the fat cells,
we think about what's not there
for premature infants
in order to help keep them warm,
it begins to make sense.
00:23
Any infant
that's small for gestational age,
which is different
than a premature infant.
00:28
Remember, those are not the same.
00:30
Any baby that's
large for gestational age
is also at risk for hypothermia.
00:36
Any infant that is not able
to maintain their blood sugar,
and it's low.
00:41
They will also be at risk
for hypothermia.
00:43
Are you seeing the theme here?
Again, anytime a baby
has an issue in one area,
they're likely to have an issue
in another.
00:53
Let's discuss the physiology
of hypothermia.
00:55
I think this will help make things
a little more clear.
00:59
When a baby is cold,
they respond to that by experiencing
a need for increase
in oxygen consumption.
01:05
In order to accomplish that
the respiratory rate goes up.
01:09
However, there's a decrease
in oxygen uptake by the lungs.
01:13
And that can lead to a decrease
in oxygen available for the tissues.
01:18
And that decrease in oxygen
available to the tissues
will lead to an increase
in anaerobic glycolysis.
01:24
So again,
as the respiratory rate goes up,
then we're going to experience
peripheral vasoconstriction
as a way to increase the oxygen
that's available to the cells.
01:34
As a result of the decrease in
uptake in oxygen by the lungs,
we're going to experience
pulmonary vasoconstriction.
01:41
So all of these things together
is going to lead to
a decrease in PO2, and pH.
01:48
And both of these factors together
are ultimately going to lead to
metabolic acidosis.
01:53
So do you see
how we're fitting things together?
So how do we assess
for hypothermia?
Well, the most obvious way
is temperature.
02:02
Now, we talked in the last slide
about routes for temperature,
whether we want to take a
temperature axillary or rectal.
02:10
We're going to always use
an axillary 10.
02:13
Remember that.
02:14
We're also, however,
going to check for respiration.
02:17
One area can affect another area.
02:21
We're going to check heart rate,
and also blood pressure
for signs of abnormality.
02:26
And finally, we're going to
also look for signs of sepsis.
02:29
Because sometimes the reason the
baby's experiencing hypothermia
is that we have an
early case of sepsis
that we just haven't noted yet.
02:38
Now, let's talk about
treatment for hypothermia.
02:41
We want to rewarm the baby
if they're cold.
02:43
But we won't want to do that
too quickly
because reheating the baby
too quickly
can actually cause apnea.
02:51
We would use a radiant warmer
in order to warm the baby up.
02:56
Now, it's important
when you place the baby
under the radiant warmer
that you don't put them
in all of their clothes.
03:01
And two, that you make sure that you
have some way to monitor temperature
so that you don't overheat the baby
which is possible.
03:09
We can also use good old
fashioned skin to skin contact
And that works as a frontline.
03:14
So if our temperature
is only slightly low,
then skin to skin contact
is perfect.
03:20
And remember the birthing person
does not have to be the one
doing the skin to skin contact.
03:24
It could be the partner, it could
be the grandparents or someone else.
03:30
We also want to provide
respiratory support.
03:33
This may be a nasal cannula,
or it may involve
more advanced technologies
such as the Neopuff.
03:39
In addition to respiratory support,
it's important to remember that
the baby needs nutritional support.
03:45
We want to avoid hypoglycemia.
03:48
If the baby's cold,
go ahead and get a blood glucose.
03:51
Remember,
if one system is affected,
it's likely that another system
is going to be affected.
03:56
And finally, as always
make sure that the baby
is not overly stressed,
not overly stimulated
with an external environment
that's very busy.
04:06
How can we prevent hypothermia?
Well make sure the baby is
eating appropriate to schedule.
04:13
Make sure that skin to skin contact
is initiated right after birth.
04:17
There's very few reasons why
skin to skin contact cannot be made.
04:21
Even if there are assessments
that need to be done.
04:23
They can usually be done while
the baby is placed on either
the birthing person,
or another parent,
or grandparents chest.
04:31
We also don't need
to bathe the baby right away.
04:34
Used to be that as soon
as the baby was born,
you talked to the baby
for a few minutes
and then we whisked
the baby away for a bath.
04:41
Well, the baby's not dirty.
04:43
And remember all that
wonderful vernix caseosa,
we want to rub it right in.
04:47
There's no reason
to bathe the baby right away.
04:50
And it also is a way
that babies can lose heat
so we can delay that bath.