Hypothermia in newborn baby

When the newborn’s axillary temperature is below 36.5˚C (97.8˚F), the condition is known as hypothermia. The normal axillary temperature of neonate is between 36.5˚C- 37.5˚C(97.8⁰F-99˚F). The newborn cannot regulate body temperature at birth and in first week of life, so the mother and family member must help the newborn to maintain temperature hypothermia is fourth leading causes of neonatal death in Nepal.

Condition Associated with Hypothermia:

• Too cool room
• Baby is in draft.
• Remain wet after birth.
• Bath given within first 24 hours.
• Baby is uncovered even for a short time.
• Baby is placed on a cold surface or near by.
• A cold wall or window.
• Baby is asphyxiated and hypoglycemic.
• Baby has an infection.
• Not feeding well.

Grades of Hypothermia:

• Cold stress: Temperature between (36.5⁰C-36⁰C) (97.8⁰F - 96.8⁰F)
• Moderate Hypothermia: Temperature (36⁰C - 32⁰C) (96.8⁰F - 90⁰F)
• Sever Hypothermia: Temperature (32⁰C or 90⁰ F)

Sign and Symptoms of Hypothermia:

• If the feet is cold - it is cold stress.
• If the feet and abdomen is cold  - it is moderate hypothermia.
• The body has axillary temperature less than 36⁰C.
• Limp or floppy (hypotonic) tone.
• Poor sucking or feeding.
• Weak cry.
• Slow and shallow breathing.
• Slow heart rate.
• Acrocynisis, apnea.
• Sclrema.

Management of Hypothermia:

• Remove wet and cold clothing if present.
• If mother is present, give the baby to her for keeping in skin to skin body contact (Kangaroo Mother Care).
• Make sure the room is rewarmed and free of drafts, the room temperature should be more than 25⁰C.
• Cover the baby in two to three layers. Cover his head and cover the mother and baby with the mother's warm clothes and a warm blanket.
• Encourage breast feeding, energy is needed to maintain body temperature.
• If the baby is too weak to suck at the breast, give expressed breast milk by cup and spoon/palady.
• Check the baby's temperature hourly
• Check the sign of infection.
• If the temperature is not normal after 2 hrs, rewarm immediately by keeping the baby in radiant warmer or incubator if available.
• Closely observe and ask the women for danger signs such as breathing difficulty, convulsion, unconsciousness and manage it on time. 
• If the baby's body temperature rises at least 0.5⁰C per hrs, the rewarming measures have been successful, continue measuring body temperature every 2 hrs until it returns to normal and proceed basic care.
• If the baby's body temperature does not rise at least 0.5⁰C per hour or return to normal after taking above measure manage transfer and referral for further care.

Prevention of Hypothermia:

At Delivery:

• Delivery on a warm room the temperature should be more than 25⁰C.( appropriate 25⁰C to 30⁰C)
• Dry baby immediately with warm clean towel.
• Wrap baby with another warm cloth and ensure the head is also covered.
• If possible keep in skip in skin to skin contact with mother in chest and cover with warm blanket.
• Do not bath the baby within the first 24 hrs of birth.
• Immediate breast feeding should be done within 1 hrs of delivery and continue exclusive breast feeding.
• Kangaroo mother care if the baby is of low birth weight/preterm.