HYPOTHERMIA IN NEONATES

Fuji Oktavia Sinurat

Gustien Enderina
Nadia Septi
Sri Endah Riestina
Introduction
10 per 1000
WHO
newborns
World
SDKI

Riskesdas
Indonesia
2007

Etiology Permenkes RI Girls : 62,5%

No.53 of 2014 Boys : 37,5%
Complication

Prevention
Definitions
Hypothermia in neonates body temperature
< 36,5oC at axillary temperture measurement.
Classifications

Mild Hypothermia 36 36,4C

Moderate Hypothermia 32 36C
Severe Hypothermia <32C
<35C : weight under 1000 gram

According to WHO
Risk Factor
Premature infant
Small for gestational age
Low birth weight <1500 gr
Prolonged resuscitation
Neonate with severe disease, sepsis
Neonate with surgical problem (defect in open abdomen)
Not immediately breastfed after birth
Cold / windy environment
Wet clothes
Inadequate warming during infant referral
Mechanism of Heat Loss
1. Conduction

Placed on unheated
Warm baby
surface

Body temperature Baby loses heat to

drops surface
2. Convection

Heat loss faster

if room temperature cool

Keep baby warmer sides up

3. Evaporation

Heat loss when moisture

turned to vapor

Dry thoroughly remove wet

linens, protect from drafts,
apply hat
4. Radiation
Heat transfer between solid
surfaces not in contact with
each other

Move away from windows

and outside wall and use
double walled incubator
Respons hypothermia for term infant
Pulmonary R to L
Hypoxemia
N vasoconstriction shunting
O
R Metabolic glucose
E rate utilization
P
I Brown fat Depletion of
N metabolism glycogen
E stores
P
H Hypoglicemia
R Peripheral
vasoconstriction O2
I
N consumption
E O2 delivery to
tissues
Hypoxia
Respons to hypothermia for preterm
infant
Pulmonary vasoconstriction ?
N
O
R Metabolic O2
E rate consumption
P
I Peripheral
N vasoconstriction
E limited
P
H O2 delivery to
Hypoxia
R tissues
I
N Depletion of
glucose
E glycogen Hypoglicemia
utilization
stores
Sign and Symptoms
Early Symptoms
Low capacity to feed
Skin discoloration from
sianosis become marmorata
cutis
Lethargy and crying weakly
Takipneua and tachycardia
Late Symptoms
Apnea, bradhycardia,
sianosis
Hypoglycemia, metabolic
acidosis, respiratory distress,
circulation problem,
hypotension until shock
 Diagnosed
History of infant bathed immediately after birth
History of infant is not drained after birth and not kept warm
History of expose to cold environment
Anamnesis History of action without additional warmth to the infant

The body temperature <36,5oC

Respiratory distress
Heart rate <100 times per minute
Physic Lazy to drink
Examination Lethargy
Hard palpable skin
Breath slowly and deeply
Treatment
Temperature 36,0oC 36,4oC
Change cold and wet clothes Get rid various risk factor and
with warm clothes, wear has pathological disorders that
and blankets with warm cause hypothermia in newborn
blankets If the babys temperature is
Skin to skin contact with normal, put on warm clothing
mother and blanket
If the babys temperature has Evaluate the babys
not improved after 30 minutes temperature for 3 hour
of skin to skin contact with
mother, place in the infant
warmer
Treatment
Temperature 32,0oC
Infant should be in infant Make sure the baby is dry
warmer or incubator to prevent to evaporation
In infant warmer or Give O2, if the baby
incubator, baby does not respiratory distress
wear clothes IVFD in acordancce with
Use probe skin is palced maintenance dose and in
on upper right abdomen fixed in incobator
Check temperature every
hours
Check blood glucose
CASE REPORT
 Identity
Name : By. DC Parents
No MR : 961665 Father : Mr. SS

Address : Borneo, Siak Mother : Mrs. DC

Hulu, Kampar Date of admission : 30th July 2017
Religion : Protestan Date of physicall
Ethnic : Batak examination : 31st July 2017
Exit date : 6th August 2017
Patient status : Alive
Anamnesis
Chief Complaint:
6 hours old infant problem feed.
 History of Present Illness
4 hours
Born on 30 July 2017,
SC with indication carried by incubator Camar 1,
PROM 2 days and transport IMD (+)
history of SC
6 hours
Neonate placed in Anxious and problem
Treatment :
infant warmer SCN I feeding, GDS 44 mg/dl, T :
formula milk 25 (36,5-37,5C),
cc/3 hours 35,5C
T: 35,6 C and
installation OGT
8 hours
10 hours 13 hours 16 hours
T : 36,1 C T : 36,7C, GDS :
GDS : 97 T : 36,5 C 104 mg/dl T : 36,5 C
mg/dl
 History of Present Illness
Days 2

Alert, pale (-), dyspneu (-), Treatment :

warm acral, weight : 2210 gr, Omeprazole 5 mg, kalnex 25
mg, Vit K 1 mg, Mikasin 16,5 NICU
T : 36,5c, GDS : 89 mg/dl,
OGT : red-black fluid mg, Bactesin 165 mg

Days 3 and 4
Alert, pale (-),
Treatment :
dyspneu (-), warm acral,
Omeprazole 5 mg, kalnex 25
Temperature and GDS in
mg, Vit K 1 mg, Mikasin 16,5
normal range, OGT : red-
mg, Bactesin 165 mg
black fluid
 History of Present Illness
Days 3, 4 and 5

Alert, pale (-), Treatment :

dyspneu (-), warm acral, Breast milk/3 hours,
SCN Mikasin 16,5 mg, Bactesin
Temperature and GDS in
normal range, OGT : clear 165 mg

Follow up
Day 7
18 Sept 2017, by phone :
Neonate home, 1 month 2 weeks after
Temperature and GDS in treated, baby is in good
normal range, weight health, weight 4000 gr,
2120 gr. Hepatitis B and BCG,
breast milk.
Pregnancy History
Multigravida, 37-38 weeks, 2 times ANC in Obstetrician.
History of vaginal discharge (+), white-yellow colour, itchy,
bad odor, untreated since 6 months pregnancy.
Parents History

Mother 23 years old, Diploma 3, housewife, no income,

BPJS
Father 35 years old, SMA, entrepreneur, income 2
million per month
Family History

First child, born in 2015, a boy, weight 2700 gram, SC

with indication Frank breech presentation
Important Things from Mother

Multigravida, PROM 2 days, SC history, vaginal discharge

history, green and thick amniotic fluid, two times ANC in
Obstetrician.
Important Things from Neonate

Anxious and problem feeding, 37-38 weeks, 2400

gram, 35,6 0C, GDS 44 mg/dL, red-black fluid on OGT.
Working Diagnosis

Term infant (3738 weeks) - Appropiate for gestational

age - low birth weight (2400 g)
Moderate hypothermia with improvement
Hypoglycemia with improvement
Suspect early sepsis
Prognosis

Quo ad vitam : Dubia ad bonam

Quo ad functionam : Dubia ad bonam
Discussion
 THEORY
Mother refered to RSUD AA caused by
premature rupture of membrane 2 days
and limitation of health facility for mother
and the baby

CASE
Mother refered to RSUD AA with complain
premature rupture of membrane 2 days
 THEORY
ANC minimal are 4 times to prevent
pregnancy and labor complication
ANC two times allow treatment of vaginal
discharge cannot be treated properly

CASE
Mother did ANC two times in midwife
 THEORY
Risk of hypothermia can caused by body
weight under 2500 gram and one of sign
of infection from untreated vaginal
discharge history

CASE
Temperature of the baby is 36,5 0C
(hypothermia)
 THEORY
Hypothermia increase requirement of body
metabolism and release glycogen reserve
hypoglikemia
Hypoglikemia also one of sign of infection

CASE
In this neonatus showed blood glucose 44
mg/dl (hypoglycemia)
 THEORY
Hypothermia is one of simptom of infection. Red-
black fluid on OGT, CRP (+), hypoglikemia, vaginal
discharge history, green and viscous amniotic fluid,
PROM 2 days are sign of infection that fulfill the
criteria of early sepsis

CASE
Decrease of body weight (8%), red-black fluid on OGT,
CRP (+), hypoglikemia, vaginal discharge history, green
and viscous amniotic fluid, PROM 2 days
 THEORY
The baby will allowed to go home after 7 days
giving antibiotic and sucking reflex is good

CASE
The baby will allowed to go home after
sucking reflex is good and bod weight
increase normally
 THEORY
WHO : Raise of body weight is 20-
30 gram/day until 3 months

CASE
Follow up : Body weight increase 1800
gram for 1 month 2 week after treatment
in hospital. Immunization Hepatitis B and
BCG was given in Posyandu
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