Temperature Regulation in LBW-Preterm Babies
Temperature Regulation in LBW and Preterm Babies
Core Concepts
- Normal Temperature Range:
- Axillary: 36.5-37.5°C
- Core: 36.8-37.8°C
- Skin: 36.0-36.5°C
- Definitions:
- Hypothermia: < 36.5°C
- Cold Stress: 36.0-36.5°C
- Moderate Hypothermia: 32.0-36.0°C
- Severe Hypothermia: < 32.0°C
- Hyperthermia: > 37.5°C
Physiological Aspects of Temperature Regulation
Challenges in Preterm/LBW Babies
- Anatomical Factors:
- High surface area to body mass ratio
- Thin skin with minimal subcutaneous fat
- Immature epidermis with high water permeability
- Limited brown fat stores
- Physiological Limitations:
- Immature vasomotor control
- Limited metabolic response to cold stress
- Reduced heat production capacity
- Inefficient shivering mechanism
Heat Loss Mechanisms
- Evaporation:
- Through skin surface
- Respiratory tract losses
- Enhanced by wet skin after birth
- Conduction:
- Contact with cold surfaces
- Cold medical equipment
- Unwarmed linens
- Convection:
- Air currents around baby
- Opening/closing incubator doors
- Ventilator gas flow
- Radiation:
- To cold walls/windows
- Through incubator walls
Temperature Assessment and Monitoring
Measurement Methods
- Core Temperature:
- Axillary measurement (gold standard)
- Rectal temperature (rarely indicated)
- Continuous skin probes
- Monitoring Frequency:
- First hour: Every 15-30 minutes
- Stable infant: Every 3-4 hours
- During procedures: More frequent
- Continuous monitoring for ELBW
Delivery Room Temperature Management
Environmental Control
- Delivery Room Setup:
- Room temperature: 25-26°C
- Close all windows/doors
- Minimize drafts
- Pre-warm resuscitation area
- Equipment Preparation:
- Pre-warmed radiant warmer
- Warmed linens/blankets
- Plastic wraps/bags
- Chemical thermal mattress
Immediate Care Steps
- Initial Stabilization:
- Immediate drying (if >28 weeks)
- Plastic wrap (if <28 weeks)
- Pre-warmed cap application
- Chemical mattress activation
- Transport Considerations:
- Pre-warmed transport incubator
- Maintaining wrap/covers
- Continuous temperature monitoring
NICU Temperature Management
Environmental Control Methods
- Incubator Management:
- Double-walled incubators
- Servo-control mode settings
- Humidity protocols:
- < 28 weeks: 80-85%
- 28-32 weeks: 70-75%
- 32-36 weeks: 60-65%
- Radiant Warmer Care:
- Servo-control settings
- Pre-warming before procedures
- Draft shields use
Care Protocols
- Routine Care:
- Minimal handling protocols
- Clustered care approach
- Pre-warming of all equipment
- Procedure Management:
- Increased environmental temperature
- Additional heat sources
- Frequent monitoring
Temperature-Related Complications
Cold Stress Effects
- Metabolic Changes:
- Increased oxygen consumption
- Glucose utilization changes
- Metabolic acidosis
- System Effects:
- Respiratory distress
- Hypoglycemia
- Coagulation abnormalities
- Delayed adaptation
Management of Temperature Instability
- Hypothermia Management:
- Gradual rewarming (0.5-1°C/hour)
- Increased environmental temperature
- Monitor vital signs closely
- Address underlying causes
- Hyperthermia Management:
- Identify cause (sepsis vs environmental)
- Gradual cooling
- Adjust environmental temperature
- Monitor for complications
Special Situations
Specific Conditions
- During Procedures:
- Surgery preparation
- Imaging studies
- Central line placement
- Transport Considerations:
- Inter-hospital transfer
- Intra-hospital movement
- Emergency situations
Quality Improvement
- Monitoring Protocols:
- Regular staff training
- Equipment maintenance
- Protocol compliance checks
- Outcome tracking
Disclaimer
The notes provided on Pediatime are generated from online resources and AI sources and have been carefully checked for accuracy. However, these notes are not intended to replace standard textbooks. They are designed to serve as a quick review and revision tool for medical students and professionals, and to aid in theory exam preparation. For comprehensive learning, please refer to recommended textbooks and guidelines.
