Newborn Thermoregulation (1) (1) (2)

Newborn Thermoregulation

Group Work/Class Teaching

• Group 1: Risk Factors

  • Identify why newborns are at risk (pathophysiology).

  • Focus on newborns with the highest risk.

• Group 2: Heat Loss Mechanism

  • Discuss how heat is lost in newborns via:

    • Conduction: Direct contact with surfaces.

    • Convection: Body heat loss to cooler air currents.

    • Evaporation: Loss of heat through fluid.

    • Radiation: Heat transfer from the body to cooler objects not in contact.

  • Discuss education points for family.

• Group 3: Assessment

  • Signs and symptoms of cold stress in newborns.

• Group 4: Nursing Interventions

  • Identify interventions to promote thermoregulation from delivery to 28 days old.

Concept of Thermoregulation

• Balance of heat production, gain, and loss (Wieland-Ladewig et al., 2014).

• Newborns at risk during the first 28 days.

• Importance of minimizing heat loss right after birth.

• Body temperature typically stabilizes within 8 to 12 hours.

Heat Loss Mechanisms

• Conduction: Direct contact, heat transfers between surfaces.

• Convection: Heat loss to cooler air currents surrounding the body.

• Radiation: Warm body surfaces heat cooler solid surfaces/elements nearby but not in contact.

• Evaporation: Loss of heat through moisture on the skin (Wieland-Ladewig et al., 2014).

Pathophysiology of Thermoregulation in Newborns

• Minimal subcutaneous tissue affecting heat retention (Wieland-Ladewig et al., 2014).

• Large body surface area in contrast to weight increases convection risks.

• Proximity of blood vessels to the skin allows for rapid environmental influence.

• Temperature differences between core and skin (conduction).

• Evaporation due to wet skin and respirations increases heat loss.

• Shivering is rare in newborns due to immaturity.

• Higher risks with low birth weight, preterm, or sick infants ("Nursing: A Concept-based", 2015).

Data Collection and Problems

• Monitor gestational and postnatal age.

• Assess SGA/IUGR/Preemie risks due to lower adipose tissue.

• Preferred temperature site: Axillary (normal range: 97.7-98.6°F).

• Continuous skin probe recommended for at-risk infants.

• Identify problems: increased respirations, work of breathing, hypoglycemia (less than 40 mg/dl), lactic acid issues, jaundice, poor weight gain.

  • Assessment: skin condition, cry responses, feeding, vital signs.

• Nursing diagnosis: Imbalanced Body Temperature, Hypothermia.

  • Focus on oxygenation and metabolism concerns.

Nursing Interventions

• Planning and Implementation

  • Educate family about thermoregulation needs.

  • Maintain warm delivery rooms; use pre-warmed blankets.

  • Practices such as swaddling, using hats, heated mattresses, and plastic wrapping for very low birth weight (VLBW) newborns.

  • Encourage skin-to-skin contact and breastfeeding.

  • Delay weighing and bathing initially.

  • Monitor temperature every 15-30 minutes (via rectal or axillary).

  • Utilize radiant heaters or incubators as needed.

  • Warm IV fluids gradually to prevent complications.

Evidence Based Practice and Cultural Considerations

• Skin-to-Skin Contact (SSC):

  • Recommended within 30 minutes to 1 hour for stable term newborns for thermal regulation.

  • SSC decreases hypothermia incidence in the first 48 hours (Nimbalkar et al., 2014).

  • Importance of recognizing individual family beliefs and cultural implications in nursing care.

References

• Nimbalkar, S. M., Patel, V. K., Patel, D. V., Nimbalkar, A. S., Sethi, A., & Phatak, A. (2014). Effect of early skin-to-skin contact following normal delivery on incidence of hypothermia in neonates more than 1800 g: randomized control trial. Journal of Perinatology 34(5), 364-368. doi: 10.1038/jp.2014.15

• Trakalo, K., Horowitz, L., & McCulloch, A. (Eds.) (2015). Nursing: A concept-based approach to learning. (Vol. 2). Boston, MA: Pearson Education, Inc.

• Wieland-Ladewig, P. A., London, M. L., & Davidson, M. R. (2014). Contemporary maternal-newborn nursing care. Upper Saddle River, NJ: Pearson Education, Inc.