Care Plan... please help!

HYPOTHERMIA IN THE NEWBORN

"Hypothermia of the newborn is due more to lack of knowledge than to lack of equipment. Incorrect care of the baby at birth is the most important factor influencing the occurrence of hypothermia.

In many hospitals, delivery rooms are not warm enough and the newborn is often left wet and uncovered after delivery until the placenta is delivered. The newborn is weighed naked and washed soon after birth. The initiation of breast-feeding is frequently delayed for many hours, and the baby is kept in a nursery, apart from the mother. Separation of the mother and baby makes it more difficult to keep the newborn warm; it also increases the risk of hospital-acquired infections and has an adverse effect on breast-feeding and bonding.

Newborns found to be hypothermic must be rewarmed as soon as possible. The temperature of the room where the rewarming takes place should be at least 25°C (77°F). Cold clothes should first be removed and replaced with pre-warmed clothes and a cap. The newborn should be quickly rewarmed; if a warming device is used, the baby should be clothed and its temperature should be checked frequently during the rewarming process. It is very important to continue feeding the baby to provide calories and fluid. Breast-feeding should resume as soon as possible. If the infant is too weak to breast-feed, breast milk can be given by nasogastric tube, spoon or cup. It is important to be aware that hypothermia can be a sign of infection. Every hypothermic newborn should therefore be assessed for infection.

In hospital a diagnosis of hypothermia is confirmed by measuring the actual body temperature with a low-reading thermometer, if available. The method used for rewarming depends on the severity of the hypothermia and the availability of staff and equipment.

In cases of mild hypothermia (body temperature 36.0-36.4°C/96.8-97.5°F), the baby can be rewarmed by skin-to-skin contact, in a warm room (at least 25°C/77°F).

In cases of moderate hypothermia (body temperature 32-35.9°C/89.6-96.6°F) the clothed baby may be rewarmed:

if nothing is available or if the baby is clinically stable, skin-to-skin contact with the mother can be used in a warm room (at least 25°C/77°F).

The rewarming process should be continued until the baby's temperature reaches the normal range. The temperature should be checked every hour, and the temperature of the device being used or the room adjusted accordingly. The baby should continue to be fed.

In cases of severe hypothermia (body temperature below 32°C/89.6°F), studies suggest that fast rewarming over a few hours is preferable to slow rewarming over several days.29,30,31 Rapid rewarming can be achieved by using a thermostatically-controlled heated mattress set at 37-38°C (98.6-100.4°F) or an air-heated incubator, with the air temperature set at 35-36°C (95-96.8°F). If no equipment is available, skin-to-skin contact or a warm room or cot can be used.

Feeding should continue, to provide calories and fluid and to prevent a drop in the blood glucose level which is a common problem in hypothermic infants. If this is not possible, monitoring blood glucose becomes important and an intravenous line should be set up to administer glucose if needed.

Once the baby's temperature reaches 34°C (93.2°F), the rewarming process should be slowed down to avoid overheating. The temperature of the incubator and the baby's body temperature should be checked every hour.

At home, skin-to-skin contact is the best method to rewarm a baby with mild hypothermia. For best effect, the room should be warm (at least 25°C/77°F), the baby should be covered with a warm blanket and be wearing a pre-warmed cap. The rewarming process should be continued until the baby's temperature reaches the normal range or the baby's feet are no longer cold. The mother should continue breast-feeding as normal.

Hot water bottles or hot stones can be dangerous: they may easily cause burns as the blood circulation in the cold skin of babies is poor. They should therefore never be put next to the baby. If used to warm a cot, they should be removed before the baby is put in.

If the baby becomes lethargic and refuses to suckle, these are danger signs and it should be taken to hospital. While being transported, the baby should be in skin-to-skin contact with the mother during transportation."