Objectives

Definition
Mechanism of heat loss and heat production
Causes
Manifestations
Risk factors
Measuring Temperature
Different ways to measure temperature: axillary, oral,
rectal and tympanic
Axillary is common
Use low set thermometers
Should be checked every 4 to 6 hours
Should be checked every hour if temperature is
outside normal range
WHO classification

Hyperthermia - > 37.5C

Hypothermia - <36.5C
mild hypothermia (Cold stress)
36C - 36.4C
moderate hypothermia - 35.9C
- 32C
severe hypothermia - <32C
Mechanism of heat loss
Convection - cooler surrounding air

Conduction - colder materials on which the

infant is resting

Radiation - nearby cooler solid objects

Evaporation - major factor

from moist skin and lungs
Mechanism of heat production
Peripheral vasoconstriction
Increase in metabolic rate
Increase in muscular activity (Shivering) below 25C
Non-shivering thermogenesis (Predominant in
neonates
Hypothermia
All neonates are at risk of hypothermia within the first
twelve hours of life
The following characteristics put newborns at a greater
risk of heat loss
Large surface area to body ratio
Decreased subcutaneous fat
Greater body water content
Immature skin
No shivering
Causes
External factors ( evaporation, conduction,
convection, radiation )

Decreased heat production due to

Any Condition causing respiratory Distress
Decreased metabolic activity
Manifestations of hypothermia
Metabolism
Metabolic acidosis
Hypoglycemia
Poor weight gain

Respiratory
hypoxia
Tachypnea
Shallow or Irregular Respirations

CNS
Bradycardia
Apnea
Lethargy
 CVS
Peripheral Vasoconstriction
Cold extremities

pink skin color

Tachycardia
increased capillary refill time
Consequences of Hypothermia
Hypoxemia from Oxygen consumption
Hypoglycemia from glucose metabolism
Respiratory & metabolic acidosis secondary to
anaerobic metabolism
Inhibition of surfactant production related to
acidosis
pulmonary blood flow related to pulmonary
vasoconstriction in response to body temperature
pulmonary vascular resistance compromises the
delivery of oxygen at the cell level
Hyperthermia
Causes
warmly dressed
Infants left near stoves or radiators
sunlight
Maternal fever
Maternal epidural anesthesia
Manifestations
Tachycardia
Hypotension
Warm extremities, flushing
Dehydration
Irritability
Lethargy
Poor feeding
Consequences
Hypotension and dehydration ( as result of increased
insensible water loss )

Seizures and apnea ( as a result of high core temperature)

Hypernatremia

Extreme cases; infant death, heat stroke, encephalopathy

syndrome
Reference
Nelson Textbook of pediatrics, 18th edition
Up To Date, 19.1
Olsson E., Neonatal cold injury
Thank You!