GDS K-19 Hipothermia & KMC

7/24/2019 GDS K-19 Hipothermia & KMC

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HIPOTHERMIAHIPOTHERMIA

Perinatology DivisionPerinatology Division

Dept. of Child Health Medical SchoolDept. of Child Health Medical SchoolUniversity of Sumatera UtaraUniversity of Sumatera Utara


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HIPOTHERMIAHIPOTHERMIA

Significant problem in neonates at

birth and even at 24 hours of age and

beyond

Mortality rate twice in hypothermic

babies

contributes to significant morbidity & mortality


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Why are newborns prone toWhy are newborns prone to

develop hypothermiadevelop hypothermia

Larger surface area per unit body weight

Decreased thermal insulation due to lack of

subcutaneous fat

Reduced amount of brown fat L!" infant#


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Non - shivering thermogenesisNon - shivering thermogenesis

$eat is produced by increasing metabolism%

especially in brown adipose tissue

!lood is warmed as it passes through the

brown fat% and it in turn warms the body


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FOUR !"S ! #$%OR# M!" &OS$ H$!' 'OFOUR !"S ! #$%OR# M!" &OS$ H$!' 'O

'H$ $#()RO#M$#''H$ $#()RO#M$#'


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HEAT LOSS.

CONDUCTION

CONVECTION

EVAPORATION

RADIATION

Transfer of body heatto skin surface.

Dry and wrap thebaby Place in a warmmattress


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HEAT LOSS

CONDUCTION

CONVECTION

EVAPORATION

RADIATION

Skin heat loss depends

on air temperature!ow.

"rap the baby andcontrol room

temperature


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HEAT LOSS.

CONDUCTION

CONVECTION

EVAPORATION

RADIATION

Depend upon airhumidity

#ontrol humidityand room

temperature


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HEAT LOSS

CONDUCTION

CONVECTION

EVAPORATION

RADIATIONThe transfer of body heatto en$ironmentaltemperature

%adiant heater and

control roomtemperature


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Warm hainWarm hain

"arm delivery room &2'()#

"arm resuscitation

*mmediate drying

Skin+to skin contact

!reastfeeding

!athing postponed

,ppropiate clothing

Mother - baby together

"arm transportation

.rofessional alert


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Normal range

!old stress

Moderate hypothermia

"evere hypothermia O#tloo$ grave% s$illed

are #rgently needed

&anger% warm baby

!a#se 'or onern

()*+o

(,*+o

(,*o

(.*o

,/illary temperature in the

newborn 0)#


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Temperat#re reordingTemperat#re reording

,/illary temperature recording for 1 minutes is

recommended for routine monitoring

Dont record rectal temperature in all babiesas a standard protocol

Record rectal temperature in a sick

hypothermic neonate


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Diagnosis of hypothermia by

human touch

Feel by touchFeel by touch

TrunkTrunk

Feel by touchFeel by touch

ExtremitiesExtremities

InterprettionInterprettion

!rm!rm !rm!rm "orml"orml

!rm!rm #ol$#ol$ #ol$ stress#ol$ stress

#ol$#ol$ #ol$#ol$ %ypothermi%ypothermi


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Prevention o' hypothermia at birthPrevention o' hypothermia at birth

Delivery in warm room

Dont bathe immediately after birth

Dry baby immediately with warm clean towel

"rap baby in pre+warmed cloth% cover head 3eep ne/t to mother

KMC = Kangaroo Mother Care


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Signs and symptoms of

hypothermia

.eripheral vasoconstriction

+ acrocyanosis% cold e/tremities

+ decreased peripheral perfusion

)S depression

+ lethargy% bradycardia% apnea% poorfeeding

*+


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Signs and symptoms cont55#

*ncreased pulmonary artery pressure

+ respiratory distress% tachypnea

)hronic signs

+ weight loss% failure to thrive


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Management6 )old stress

)over ade7uately + remove cold clothes and replace with

warm clothes

"arm room8bed

9ake measures to reduce heat loss

:nsure skin+to+skin contact with mother; if not possible%

keep ne/t to mother after fully covering the baby

!reast feeding

Monitor a/illary temperature every < hour till it reaches 1=5'0)% then hourly for

ne/t 4 hours% 2 hourly for >2 hours thereafter and 1 hourly as a routine


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Management6 Moderate

hypothermia1250() to 1'5?() #

Skin to skin contact

"arm room8bed


.rovide e/tra heat

+ $eater% warmer% incubator

+ ,pply warm towels


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In&nt !rmerIncubtor


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2'

Management6 Severe

hypothermia @120)# .rovide e/tra heat preferably under radiant warmer or

air heated incubator

+ rapidly warm till 140)% then slow re+warming


*A fluids6 =0+B0 ml8kg of >0C De/trose

/ygen

*f still hypothermic% consider antibiotics assuming

sepsis Monitor $R% !.% Elucose if available)


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//angarooangaroo

MMotherother!!areare


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What is /M!What is /M!

,, special way of caring for Low birth weightspecial way of caring for Low birth weight

L!"# babiesL!"# babies

*t promotes*t promotes

:ffective thermal control:ffective thermal control

!reast feeding!reast feeding

.revention of infection.revention of infection

.arental bonding.arental bonding


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!omponents o' /M!!omponents o' /M!

Skin+to+skin contactSkin+to+skin contact

:arly% continuous and:arly% continuous and

prolonged skin+to+prolonged skin+to+

skin contactskin contact

:/clusive breast feeding:/clusive breast feeding

.romotes lactation and.romotes lactation andfacilitates feedingfacilitates feeding


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0ene'its o' /M!0ene'its o' /M!

0reast 'eeding0reast 'eeding *ncreased breast feeding rates*ncreased breast feeding rates

*ncreased duration of breast*ncreased duration of breast

feedingfeeding

Thermal ontrolThermal ontrol :ffective thermal control:ffective thermal control

:7uivalent to conventional:7uivalent to conventional

incubator careincubator care


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0ene'its o' /M! 10ene'its o' /M! 1cont..cont..22

Early dishargeEarly disharge

( !etter weight gain!etter weight gain:arly discharge:arly discharge

3esser morbidity3esser morbidity

( Regular breathingRegular breathingF Decreased episodes of apneaDecreased episodes of apneaF .rotection from nosocomial infections.rotection from nosocomial infections


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Other bene'itsOther bene'its

Less stress to the infantLess stress to the infant Stronger bondingStronger bonding

Deep satisfaction for motherDeep satisfaction for mother

More confident parentsMore confident parents

0ene'its o' /M! 10ene'its o' /M! 1cont..cont..22


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Re4#irements 'or /M!Re4#irements 'or /M!

implementationimplementation

TrainingTraining

urses% physicians and other staffurses% physicians and other staff

Ed#ational materialEd#ational material

*nformation sheets% posters and video films on*nformation sheets% posters and video films on

3M)3M)

5#rnit#re5#rnit#re Semi+reclining easy chairsSemi+reclining easy chairs

!eds with adGustable back!eds with adGustable backrestrest


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Eligibility riteria6 0abyEligibility riteria6 0aby

%irth ,eight -*// gm0%irth ,eight -*// gm0

Start at birthStart at birth

%irth ,eight *1//2*3++ gm0%irth ,eight *1//2*3++ gm0 $emodynamically stable$emodynamically stable

%irth ,eight 4*1// gm0%irth ,eight 4*1// gm0

$emodynamically stable$emodynamically stable

Hemodynamic sta5ility is a MUS'


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"illingness"illingness Eeneral health - nutritionEeneral health - nutrition

$ygiene$ygiene

Supportive familySupportive family

Supportive communitySupportive community

Eligibility riteria6 MotherEligibility riteria6 Mother


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Preparing 'or /M!Preparing 'or /M!

!o#nseling!o#nseling Demonstrate procedureDemonstrate procedure

:nsure family support:nsure family support

3M) support group3M) support group

Mother7s lothingMother7s lothing Hront+open% light dress as per the local cultureHront+open% light dress as per the local culture

%a5y6s clothing%a5y6s clothing )ap% socks% nappy and front+open sleeveless)ap% socks% nappy and front+open sleeveless

shirtshirt


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/M! proed#re6/M! proed#re6

/angaroo positioning/angaroo positioning

.lace baby between the mothers breasts in.lace baby between the mothers breasts in

an upright positionan upright position

$ead turned to one side and slightly e/tended$ead turned to one side and slightly e/tended

$ips fle/ed and abducted in a IfrogJ position;$ips fle/ed and abducted in a IfrogJ position;

arms fle/edarms fle/ed

!abys abdomen at mothers epigastrium!abys abdomen at mothers epigastrium

Support babys bottomSupport babys bottom


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/M! proed#re6/M! proed#re6

/angaroo positioning 1/angaroo positioning 1cont..cont..22

Head turned

to one side

Frog2leg

position

%a5y 5et,eenmother6s 5reasts

Support 5a5y6s

5ottom


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Monitoring d#ring /M!Monitoring d#ring /M!

!he$ i'!he$ i'

eck position is neutraleck position is neutral

,irway is clear,irway is clear

!reathing is regular!reathing is regular

)olor is pink)olor is pink 9emperature is being maintained9emperature is being maintained


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Initiation o' /M!Initiation o' /M!

!aby should be stable!aby should be stable

Short 3M) sessions can be initiatedShort 3M) sessions can be initiatedeven if the baby is receivingeven if the baby is receiving

*A fluids*A fluids

/ygen therapy/ygen therapy rogastric tube feedingrogastric tube feeding


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ration o' /angaroo Motherration o' /angaroo Mother

!are!are

Start 3M) sessions in the nurseryStart 3M) sessions in the nursery

.ractice one hour sessions initially.ractice one hour sessions initially

9ransit from conventional care to longer9ransit from conventional care to longer3M)3M)

9ransfer baby to post+natal ward and9ransfer baby to post+natal ward and

continue 3M)continue 3M) *ncrease duration up to 24 hours a day*ncrease duration up to 24 hours a day


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/M! d#ring sleep and resting/M! d#ring sleep and resting

RestingResting

Reclining or semi+recumbent positionReclining or semi+recumbent position

,dGustable bed,dGustable bed Several pillows on an ordinary bedSeveral pillows on an ordinary bed

:asy reclining chair:asy reclining chair

"leep"leep

Supporting garment restraint for babySupporting garment restraint for baby


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Father 7 other family mem5ers can

also provide s8in2to2s8in care


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/M! d#ring sleep/M! d#ring sleep


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&isharge riteria&isharge riteria

!aby is well with no evidence of infection!aby is well with no evidence of infection

Heeding well predominant breast milk#Heeding well predominant breast milk#

Eaining weight >'+20 gm8kg8day#Eaining weight >'+20 gm8kg8day# Maintaining body temperature in roomMaintaining body temperature in room

temperature#temperature#

Mother confident of taking care of the babyMother confident of taking care of the baby Hollow+up visits ensuredHollow+up visits ensured


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&isontin#ation o' /M!&isontin#ation o' /M!

9erm gestation9erm gestation

"eight K 2'00 gm"eight K 2'00 gm

!aby uncomfortable!aby uncomfortable "riggling out"riggling out

.ulls limbs out.ulls limbs out

)ries and fusses)ries and fusses)other cn continue *)# &ter +i,in+ the bby)other cn continue *)# &ter +i,in+ the bby

bth n$ $urin+ col$ ni+hts bth n$ $urin+ col$ ni+hts


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Documents

GDS K-19 Hipothermia & KMC