Hypothermia – Newborn Complications (Nursing)

by Jacquelyn McMillian-Bohler, PhD, CNM

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    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.

    About the Lecture

    The lecture Hypothermia – Newborn Complications (Nursing) by Jacquelyn McMillian-Bohler, PhD, CNM is from the course Newborn Complications (Nursing).

    Included Quiz Questions

    1. Axillary temperature
    2. Respirations
    3. Blood pressure
    4. Signs of sepsis
    5. Rectal temperature
    1. Placing the newborn in a radiant warmer, clothed and wrapped in a blanket
    2. Rewarm slowly
    3. Respiratory support
    4. Nutritional support
    5. Decrease stimuli

    Author of lecture Hypothermia – Newborn Complications (Nursing)

     Jacquelyn McMillian-Bohler, PhD, CNM

    Jacquelyn McMillian-Bohler, PhD, CNM

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