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What is thermoregulation?
The maintenance of equality between the heat dissipation and heat production from the body.
What is themal neutral zone?
When the infant is neither gaining nor loosing heat and the oxygen consumption is its lowest, then balance is achieved.
What is desired Rectal and Skin Temperature?
- rectal temperature at 36.5-37.5
- skin temperature 36-36.5
What is Internal Thermal Gradient, and what is it regulated by?
- The difference in temperature between the warm core of the body and the cool skin
- - Regulated by:
- The metabolic rate.
- The amount of subcutaneous fat.
- The body surface area.
- The distance from the body core to the skin surface
What is non shivering thermogenesis?
increased heat production due to burning of brown fat
Why do preemies have a difficult time regulating ITG (Internal Thermal Gradient)?
- A large amount of skin surface to body weight.
- Relatively thin layers of skin.
- Low amounts of body fat.
- A high metabolic rate and rarely get enough calories to keep them warm
What are the 4 types of heat loss that concerns us in the NICU?
What is Radiant heat loss?
Dissipation of heat to surrounding objects not in direct contact with them
What is Conductive heat loss?
Transfer of heat to cooler surfaces in contact with the infant like wet blankets or cold stethoscope.
What is Convective heat loss?
Loss of heat from the skin to surrounding air. Air currents carry away warm blanket of air around them
What is Evaporative heat loss?
As liquids (urine, sweat) evaporate, they carry away heat
What is Hypothermia in a newborn referred to as and hazards of it?
- - Cold Stress:
- The initial response to cold stress is vasoconstriction to shunt away from the skin.
- - This leads to:
- Anaerobic metabolism in shunted areas causing metabolic acidosis.
- Pulmonary vasoconstriction and worsens the hypoxemia and acidosis but altering the V/Q ratio.
- Hypoxemia, further worsening the response to hypothermia
___________ also triggers nonshivering thermogenesis and fat metabolism to produce heat resulting in further acidosis and hypoglycemia. All of these factors will keep the infant warm for a while. If the cold stress if corrected, the neonate may recover with no harm
___________ produces initial vasodilation to dissipate heat and is soon followed by increased metabolism and oxygen consumption
What cause Hyperthermia?
- Malfunctioning incubator.
- Radiant warmer.
- Phototherapy lights
What is Insensible Water Loss?
- Extra cellular fluid makes up 45% of body weight of a term infant vs. 60% of a 32 week infant.
- This means that the more premature the infant, the more they are prone to insensible water loss
What are some factors the cause Insensible Water Loss?
- Increased motor activity.
- Skin break down.
- Respiratory distress.
- Congenital skin defects.
- Environmental temperature.
What is an Isolette?
An Isolette (incubator) is an environmental containment chambers that contains the neonate in a controlled temperature, humidity, and oxygen.
What are the Advantages and Disadvantages of an Isolette?
- They are easy to operate but hard to control due to frequent opening.
- The neonate is not readily accessible inside the plastic case.
- If the incubator can be left closed they work well and maintain temperature without undue increases in room temperature
What is a Radiant Warmer?
Radiant (i.e. open) warmers make the neonate more accessible.
What are the Advantages an Disadvatages of Radiant Warmers?
- They are usually servo controlled to maintain the core temperature of the neonate.
- However, the neonate is openly exposed to the environment.
- Core temperatures of the maintained easily, but cold stress still may occur because the inability to control the environment
What are the effects of Overstimulation of a newborn?
- Sensory overload from the noise, light, and activities of the NICU provide too much stimulation to the eyes, ears, and brain of the neonate.
- This can interfere with both the development and organization of the central nervous system
What is behavioral-based care?
- Handling only when the behavioral and physiological sign indicate.
- Behavioral-based care seeks provide basic care during times of non-stress:
- - In theory, this will reduce overstimulation
What can cause Skin Trauma to a newborn, and what are the risks of it?
- Because the skin is so thin, removing tape, excessive handling, and other such activities may tear the skin.
- This causes the break down the first barrier of their defense system.
- This leaves the premature infant much more susceptible to infection.
How do we reduce the risks of Skin Trauma to a newborn?
- Use mild soaps applied with cotton ball when cleaning.
- Use ETT holders as opposed to taping.
- Appropriate placement and relocation of devices like transcutaneous monitors.
- Using elastic wraps rather than tape to hold pulse oximeter sensors in place.
- Use of transparent IV dressings.
- Increasing the infant's environmental humidity.
What are the different electrolytes that concern us and what do they do?
- Sodium - water balance
- Potassium - acid-base balance and hydrogen diffusion (both are positively charged)
- Calcium - integral for heart function and bone integrity
- Magnesium - necessary for calcium regulation
- Chloride - anion gap and Hamburger phenomenon
- Phosphate - essential in energy metabolism
Review Table 7-5 on slide 25.
Do it? Eright good.
What is Jaundice (Hyperbilirubanemia) and facts about it?
- Jaundice is the yellow-orange skin color associated with abnormal levels of biliruban.
- Most biliruban comes from the breakdown of old red blood cells.
- It is common in neonates.
- 25 to 50% of all term infants.
- Higher percentage in premies.
What causes an increase in biliruban (jaundice)?
- The higher percentage of red blood cells.
- The shorter life span of red blood cells.
- The inability of the neonatal liver to conjugate the excess biliruban.
What are compications associated with Jaundice?
- Encephalopathy is the most serious complication associated with pathologic jaundice.
- This is because the fat from the unconjugated biliruban crosses the blood-brain and attaches itself to the brain cells.
- Hyperbilirubanemia, untreated can then lead to permanent brain damage and developmental delay.
How do you treat Jaundice?
- Phototherapy (mostly used), where blue light causes the biliruban to decompose into water-soluble particles with are excreted by the kidneys.
- Phenobarbital, increases conjugation.
- Exchange transfusion, replacing the effected RBC's.
What is Necrotizing Enterocolitis (NEC) characterized by?
- NEC is characterized by ischemia and necrosis of the intestines.
- Untreated it may lead to abdominal distention, perforation, sepsis, and maybe death
What is Necrotizing Enterocolitis (NEC) associated with?
- Necrotizing entercolitis (NEC) is an idiopathic disorder associated with:
- - Mucosal wall injury.
- - Bacterial invasion of the damaged area.
- - Formula feeding.
What is Necrotizing Enterocolitis (NEC)?
Break down and destruction of a portion of the intestines
What are Clinical signs of Necrotizing Enterocolitis (NEC)?
- Blood in the stool.
- Bile tinged vomiting.
- Abdominal distention.
- Pneumatosis on x-ray (abnormal presence of air)
- General signs of sepsis.
- Poorly tolerated feeding.
- Increased O2 requirements. (pressure pushes on lungs cause smaller Vt)
What is the Treatment for Necrotizing Enterocolitis (NEC)?
- Prevention is the best treatment.
- Good hand washing technique.
- Stop feedings.
- NG suctioning to remove bile residue.
- Frequent abdominal x-rays.
- Surgical intervention to repair perforated or necrotic intestines.