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22 Cards in this Set
- Front
- Back
Babies at risk for temp instability (12!) |
-Inappropriate environment -Malfunctioning equipment -Transported babies -Preterms -SGA (not enough fat) -Endocrine problems -Cardiorespiratory abnormalities -Abdominal wall defects -Spinal defects -CNS abnormalities / damage -Neuromuscular abnormalities (hypotonia = not flexed = loss of heat) -Sepsis |
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Clinical presentation of hypothermia (9) |
-Pale -Cool to touch -Acrocyanosis -Central cyanosis -Apnea -Bradycardia -Respiratory distress -Irritability --> lethargy -Feeding intolerance |
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Defenses against heat loss (4) |
1. flexed position of healthy term infant 2. Peripheral vasoconstriction 3. Shivering thermogenesis 4. Nonshivering thermogenesis |
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Shivering thermogenesis |
Poorly developed in NBN Cold --> brain stem --> spinal cord --> anterior motor neurons --> increased muscle tone --> increased muscle metabolism --> heat production |
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Non shivering thermogenesis |
Main method of heat production for newborn Cold stress --> hypothalamus -->epinephrine --> brown fat metabolism (TEMPORARY, only in nbn) |
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What is the function of brown fat? When does it develop? |
ONLY function is heat production Develops ~ 26 weeks GA through 3-5 weeks post-birth Accounts for 1/10th adipose tissue in full term Appearance: smaller vacuoles than white fat (increased glucose, mitochondria, sympathetic nerves, blood supply) |
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Location of brown fat metabolism |
mid scapula back of neck under clavicles abdominal aorta esophagus mediastinum trachea heart liver kidneys adrenal glands |
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Brown fat ______ releases heat into the _______ |
Brown fat lipolysis releases heat into the circulating blood - transfers heat to other parts of body -NEEDS increased O2 and glucose |
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What happens if body can't keep up with the metabolic demands of cold stress? |
increased metabolism 100% by 15-30 min, increased to 170% by 1 week of age (term infant) --> leads to respiratory distress, loss of weight, failure to gain weight, decreased surfactant production, pulmonary vasoconstriction, hypoxia |
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Classifications of hypothermia (mild/mod/severe) |
Mild - 36.0-36.4 Moderate - 32-35.9 Severe - < 32 |
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Mild vs severe thermal stress effects |
Mild - helps establish respiration, thyroid and catecholamine surge Severe - acidosis, hypoxia, hypoglycemia, DIC, IVH, shock, death |
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Why tub bath over sponge bath? |
Tub bath - decreases temperature loss, no differences in umbilical cord healing, behavior more content |
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What should you do in delivery room for babies < 1500 gm or at high risk of hypothermia? |
-Bowel bag / plastic wrap -Place on blanket covered thermal mattress -Double hat |
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Conduction |
direct contact with scales, blankets, diapers, etc
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Convection |
Depends on air temp, air flow, relative humidity, clothes, hat Head is 21% of body surface (brain produces 44% of heat) Minimize: increase environmental temperature, eliminate drafts, cover baby's head, dress baby, heat O2 |
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Evaporation |
Loss of heat when water evaporates from skin & respiratory tract; depends on air flow and humidity BIGGEST SOURCE OF HEAT LOSS 58 calories lost for every gram of H20 evaporated Minimize: Dry and remove wet blankets or use plastic, increase temp, increase humidity, no drafts, heat & humidify O2, warm solutions before contact with baby, delay 1st bath until temp stable |
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Radiation |
Radiation to walls, windows, objects NOT in direct contact Minimize: keep baby away from outside walls & windows, dress baby, use double walled incubator, mylar blankets for transport |
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Major concern with rewarming too quickly |
BP may drop as baby re-warms Vasoconstriction ---> Vasodilation |
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What is the recommendation for re-warming? |
1 degree C / hr OR 0.5 degree C/ hr if < 1200 gm, < 28 weeks, if temp is < 32 *Set control temp 1-1.5 C higher than infant's current skin temperature |
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Weaning from isolette requirements |
After 30-32 weeks and/or 1500 gms When temp stable at 28 C or less in an isolette for at least 12-24 hrs |
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Can you warm a cold preemie by putting more clothes on or more blankets? |
NO!!! Need external heat source / skin to skin warmth |
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Hyperthermia clinical presentation (6) |
-Hypotension -Apnea -Tachypnea -Dehydration -Seizures -Sweating |