Womens & Childrens Services Clinical Guidelines SDMS ID: P2010/0393-001 WACS ClinProc 4.

17 Title: Replaces: Description: Target Audience: Key Words: Policy Supported:

Management of Newborn Hypothermia

Neonatal Management Care and Assessment of the Normal Newborn Policy 4.3 Management newborn hypothermia Midwifery and Medical Staff, Queen Victoria Maternity Unit Newborn, temperature, hypothermia, heat loss
P2010/ 0382-001 Care of the Well Newborn

Purpose: To ensure that the immediate care of the newborn at birth facilitates adaptation to extrauterine life preventing neonatal hypothermia. Definition Hypothermia is a temperature less than 36.5C Prevention of Newborn Hypothermia Minimise heat loss from the newborn by: Pre-warm any hats, blankets and clothing prior to birth Pre-warm the resuscitation area Maintain the temperature in the birth room at > 25C Place the baby in immediate skin to skin contact with the mother Dry the baby immediately and remove wet towels or blankets Initiate breastfeeding to provide fuel for the babys temperature maintenance Do not bath the baby until the temperature has been stable for at least 4hours Management of Hypothermia If the newborns temperature is below 35.9C per axilla - check rectal temperature. If rectal temperature below 35.5C urgent admission to 4N for further management is required. If newborns temperature is below 36.5C then: place newborn skin to skin with mother and cover with warm blanket OR place hat and booties on newborn wrap baby in pre warmed blanket OR place under radiant heater with skin exposed to the heater Check temperature every 30 minutes until temperature above 36.5C. Consider blood glucose level if the temperature is not increasing when checked. When newborns temperature is above 36.5C then: remove from heater
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continue to check temperature regularly and remove extra blankets and wraps when appropriate monitor temperature for 24 hours or until stable.

If temperature remains less than 36.5C: leave under heater maximum time under the heater should be four hours take temperature every 30 minutes until temperature 36.5C if temperature has not risen above 36.5C after four hours notify paediatric registrar consider blood glucose level assessment. Newborns at risk of Hypothermia Preterm infants and small for gestational age babies have less adipose tissue and a greater surface area to mass ratio than full-term babies. The lower the gestational age, the less brown adipose tissue is deposited and the less body and limbs are flexed. Consequently these babies are extremely vulnerable to hypothermia. They require a higher environmental temperature to maintain a thermoneutral range. Clinical Note Clothed babies who become hypothermic in an appropriately warm environment need very prompt medical assessment and investigation, especially for infection. In these circumstances the low temperature is likely to indicate a serious illness (usually an infection) rather than an environmental cause for the hypothermia.

Attachment 1

References

Performance Indicators: Evaluation of compliance with guideline to be achieved through medical record audit annually by clinical Quality improvement Midwife WACS Review Date: Annually verified for currency or as changes occur, and reviewed every 3 years via Policy and Procedure working group coordinated by the Clinical and Quality improvement midwife. November 2009 Midwives and medical staff WACS Dr A Dennis Co-Director (Medical) Sue McBeath Co-Director (Nursing & Midwifery) Womens & Childrens Services

Stakeholders: Developed by:

Dr A Dennis Co-Director (Medical) Womens & Childrens Services

Sue McBeath Co-Director (Nursing & Midwifery) Womens & Childrens Services

Date: _________________________

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APPENDIX 1 REFERENCES Joanna Briggs Institute 2006 Newborn: Delivery Room: Initial Care Online: http://www.joannabriggs.edu.au/cis/gu_manual_index.php Pairman S, Pincombe J, Thorogood C, Tracy S, Midwifery preparation for practice 2006 Elsevier Australia Queensland Health Southern Zone Neonatal Clinical Practice Guideline 2004 Prevention and Management of Hypothermia and Hyperthermia in the Neonate (thermoregulation) Womens Hospitals Australasia Care of the Unwell Baby Clinical Forum. Womens and Childrens Hospital Campus Nursing and Midwifery Clinical Standards 2006 Hypo/hyperthermic management Neonate Womens Hospitals Australasia Care of the Unwell Baby Clinical Forum.

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