Question

An infant born 2 hours ago is at risk for cold stress in the immediate newborn transition phase. What are the dangers of cold stress on a newborn that the nurse must be aware of? What measures can the nurse apply to prevent cold stress from occurring?

Answer 1

Thermoregulation is important in newborn care. Most of the heat loss is occurred by conduction, evaporation, convection, radiation. The heat production is occurring in newborn by brown adipose tissue in the form non shivering thermo genesis which helps to maintain temperature by stimulating hypothalamus and spinal cord.

Cold stress is the stage of hypothermia when the baby’s body temperature falls from 36 to 36.4 C. Infants has ability to maintain thermoregulation by means of brown adipose tissue. But it may be low for who are born before term, infant with asphyxia. It depends on body surface areas of body, maturity of baby. Because baby with large surface area, large head, prematurity

Reason for hypothermia:

· The temperature of the uterine is different from temperature of extra uterine environment

· The cooler temperature of the labor room

· Lack of warming of baby before and after transporting baby

· The infant whose weight is low and preterm baby with low subcutaneous tissue and lack of brown fat to maintain temperature

· The infant with asphyxia, certain form anomalies,

· The surrounding environment are cooler taht is walls, tables, equipment,clothes. it increases heat loss by the radiation. open window is reason for radiant heat loss that occur in the new born

Dangerous to cold stress

The new born chances to have serious consequences. They are hypoglycemia, hypoxemia, delayed growth, metabolic acidosis, respiratory distress syndrome, sepsis, clotting disorders, mental retardation, pulmonary hemorrhage, and acrocyanosis, and bradycardia, feeble cry

1. Hypoxemia; when temperature of new born I slow, increase metabolic rate, it increase oxygen demands. As a result, there is a reduction of surfactant production, causing reduced expansion of lungs. This results hypoxemia

2. hypoglycemia: when the temperature is low, it increase metabolic rate, it increase glucose consumption to meet metabolic demands, transferring glycogen to glucose, causing increase use of glucose by the body leads to hypoglycemia

3. delayed growth: the baby has used most of the glucose for maintaining temperature causing low glucose for growth

4. Metabolic acidosis and   neonatal jaundice: it happens when the new born body uses brown fat for maintaining thermoregulation, causing acid production, leas metabolic acidosis. As a result of fatty acids inhibit transport of bilirubin to the liver. It leads to higher bilirubin in the blood

Nursing measures

After delivery

1. After delivery of newborn, drying of baby with a warm clothes helps to prevent the heat loss

2. Ensure that environment in the delivery room is warm. That should be 25 to 28 C for full term baby; 23-25 C is for preterm baby. There should not any drought from open window. Instrument in the delivery room should be warm

3. Baby is assessed in the radiant warmer in order to prevent hypothermia while examination

4. After examination of baby, allow the baby to lie on mother side. It maintains the temperature

5. Allow the baby to suck in order to get warmth of mother and also nutrition creates bonding between baby and mother. Breast feeding should be initiated within hours of delivery

6. After feeding, the baby should be transported in layer of cloth and keep the baby in layer of linen with plastic sheet.

7. After shifting of mother, the baby should be kept near the mother for 24 hours a day

8. Educate the mother regarding the breastfeeding that should be given on demand. Avoid excessive crying of baby because excessive crying causes hypoglycemia

9. Monitor baby temperature and his condition in order to ensure normal temperature

10. Educate mother and family importance of warming and covering the baby along with importance of breast feeding

11. Educate mother how to monitor the baby. In case of cold stress, extremities are cold and abdomen is warm

12. Advise the family to cover the babies in warm clothes while transporting for example for going immunization, for any blood test

When the mother in the post operative ward or in case of sick mother

1. Ensure the baby is covered in layer of linen cloth and cover extremities ear

2. Educate the family to remove cooler clothe from room

3. Educate the family to do sponge bath with warm water   until the umbilical cord falls

4. Ensure the baby is kept on the linen clothe. Because contacting with cold surfaces are reason for heat loses by the conduction

5. monitor baby temperature that should be 36 to 36.5 C

6. encourage the mother to breast feed baby to provide warmth,

7. advice the family to close window while the baby in the room in order to avoid heat loss by convection and cooler tables and vessels near the baby in order to avoid heat loss by radiation