Hypothermia in Newborn/Fever in Child

Heat Regulation in Newborns

1. Heat Loss 2. Thermogenesis

Pharmacological interventions

Acetaminophen Nonsteroidal Anti-inflammatory Drugs (NSAIDs) AVOID Aspirin --> risk of Reye's syndrome

Most effective intervention for a fever........

Antipyretics -Acetaminophen -NSAIDs -NOT aspirin

Next to establishing respirations and adequate circulation, heat regulation is the most critical to the newborn's survival

Next to establishing respirations and adequate circulation, heat regulation is the most critical to the newborn's survival

An elevated temperature, most frequently from ________, but occasionally from hyperthermia, is one of the most _____________ symptoms of illness found in ______________.

fever, common, children.

Brown Fat

located in the superficial deposits

Thermoregulation

the maintenance of balance between heat loss and heat production

Clinical Management/Goal of Care

to maintain a neutral thermal environment for the neonate in which heat balance is maintained

Factors that influence heat loss include

-temperature & humidity of the air -flow and velocity of the air -temperature of surfaces in contact with and around the infant

Risk Factors (Hypothermia in Newborn)

-thin layer of subcutaneous fat -blood vessels are close to surface of skin -changes in temp (environment) can affect the blood temperature -larger surface-to-body weight ratio

Most effective intervention for hyperthermia.....

(antipyretics are of no value) Cooling Measures are used on the skin to help reduce the core temperature

Clinical Management of Elevated Temperature (Fever)

****** RELIEVE DISCOMFORT***** -remain hydrated -rest -pharmacological interventions -environmental interventions (only after pharmacological)

**Hypothermia is a common and dangerous problem in the newborn **

**Hypothermia is a common and dangerous problem in the newborn **

Cold Stress

-imposes metabolic and physiologic demands on all infants, regardless of gestational age and condition -respiratory rate increases -O2 consumption and energy are diverted from making normal brain and cardiac function and growth consequence: hypoglycemia

Physical Benefits of Fever

-increased WBC activity -increased interferon production and effectiveness -antibody production -some enhancement of antibiotic effects

Clinical Manifestations/Assessment (Newborn)

-muscle activity increases (NOT shivering) -increased crying -restlessness -cool skin -acrocyanosis (on extremities) -position of flexion -metabolic activity increases resulting in increased oxygen demand

The ability to concentrate urine is fully attained by about _____________ months of age

3

At birth, a small quantity of urine is usually present in full-term infant, many newborns void. (This is important to note)

At birth, a small quantity of urine is usually present in full-term infant, many newborns void. (This is important to note)

Clinical Manifestations/Assessments (Child)

elevated temperature shivering vasoconstriction warm, flushed skin diaphoresis feeling cold increased heart rate increased muscle tone (stiffness)

Risk Factors (Fever in Child)

infection from pyrogen (bacteria, virus) susceptibility of host (immunocomprised, endogenous source, autoimmune disorder, disease)

How do newborns lose heat through.... Convection Radiation Evaporation Conduction & interventions

loss of heat through air currents (keep infant away from window, put a cap on baby's head) emit heat from skin surface to air (warming light/incubator) evaporation of moisture from the skin surface (make sure baby is dried right away, quick baths, check water temp) transfer of heat through direct contact (kangaroo care, place blankets on surfaces where infant will rest)

Nonshivering Thermogenesis

metabolism of brown fat and then by increased metabolic activity in brain, heart, and liver

Goal of treating a fever

relief of discomfort