Question

Six hours after birth, an infant is found to have an axil- lary temperature of 97F. The child is placed in an overbed warmer. When the nurse tells the mother that the infant will not be able to leave the nursery at the next feeding, the mother asks why this low tempera- ture is a concern. The nurse explains that low body temperature in the newborn can cause which effects? (Select all that apply.)

Short answer

Low body temperature in newborns can lead to increased oxygen demand, caloric expenditure, difficulty with blood sugar regulation, increased respiratory rate, potential respiratory distress, and hypoglycemia.

Step-by-step solution

Understanding the Importance of Normal Body Temperature

Explain that maintaining a normal body temperature is critical for newborns since their systems are still adapting to life outside the womb. A stable body temperature helps with metabolic processes necessary for survival.

Explaining the Risks of Hypothermia in Newborns

Inform the mother that low body temperature, or hypothermia, can lead to increased oxygen demand and caloric expenditure as the baby's body tries to generate heat. This stress can result in difficulty with blood sugar regulation and can negatively affect their breathing.

Discussing Possible Hypoglycemia

Mention that low body temperature may also cause hypoglycemia (low blood sugar) in newborns, which is risky since glucose is the main source of energy for the baby's brain.

Identifying Potential Respiratory Problems

Clarify that an infant's attempt to warm itself might lead to increased respiratory rate and potential respiratory distress, which is a serious complication that requires immediate attention in a newborn.

Summarizing the Need for Monitoring

Highlight the need to keep the infant in the nursery under observation and possibly in an overbed warmer to ensure the body temperature is regulated, thus preventing the onset of these conditions.

Key concepts

Importance of Normal Body Temperature in Newborns

Maintaining a normal body temperature is vital for newborns. At birth, a baby's body must make a rapid adjustment from the temperature-controlled environment of the womb to the vastly different conditions of the outside world. A stable body temperature supports essential metabolic functions, such as heart rate and breathing, enzyme efficiency, and overall organ operation. Newborns, in particular, lack the fully developed mechanisms adults have to regulate their temperature and are more susceptible to heat loss. This situation requires careful monitoring to ensure newborns maintain a body temperature between 97.7°F (36.5°C) and 98.6°F (37°C).

It's essential for caregivers to understand that a deviation from this temperature range can lead to significant health complications, and therefore, must be addressed promptly to safeguard the newborn's health and wellbeing.

Risks of Hypothermia in Newborns

Hypothermia occurs when a newborn's body temperature falls below the normal range. This can have serious repercussions. Firstly, it increases the infant's oxygen requirement because the body consumes more oxygen to generate heat. Additionally, hypothermia can lead to an increased caloric demand as the baby burns through energy reserves to maintain body warmth. This situation is particularly concerning as it can quickly exhaust the limited energy stores of a newborn, potentially leading to newborn hypoglycemia. Other risks include impairing the immune response, increasing the likelihood of infections, and adding strain on the cardiovascular system. These aspects highlight why it's critical for healthcare providers to take immediate steps, such as using an overbed warmer, to rectify the newborn's body temperature and minimize these risks.

By doing so, they can prevent the cascade of physiological challenges that cold stress presents to a vulnerable infant.

Newborn Hypoglycemia

Hypoglycemia in newborns, or low blood sugar levels, is a concern because the brain depends on glucose for energy. Newborns are especially at risk because of their limited glycogen stores and high cerebral glucose consumption. When a newborn experiences hypothermia, the body accelerates glucose consumption to generate heat, which can rapidly deplete these stores, leading to hypoglycemia. The symptoms might include jitteriness, feeding difficulties, respiratory distress, lethargy, and even seizures in severe cases.

Monitoring glucose levels in infants with hypothermia is therefore crucial, as early detection and treatment of hypoglycemia can prevent permanent brain injury or other severe outcomes. Healthcare providers need to ensure that adequate feeding and appropriate thermal support are in place to manage and prevent hypoglycemia.

Neonatal Respiratory Distress

Respiratory distress in newborns is a potentially life-threatening condition that can be exacerbated by hypothermia. When an infant is cold-stressed, they may breathe faster and more shallowly in an effort to increase oxygen intake and metabolic heat production. This can lead to respiratory distress, characterized by symptoms such as grunting, flaring nostrils, retractions, and cyanosis.

Respiratory distress requires immediate medical intervention because newborns have a limited reserve to cope with increased breathing workloads. It's essential for healthcare professionals to monitor the respiratory status of hypothermic infants closely, ensuring that they receive the oxygen and support needed to maintain adequate breathing while they are rewarmed.

Newborn Temperature Regulation

A newborn's ability to regulate body temperature is immature, making them highly reliant on external sources for warmth. Unlike adults, newborns have a larger surface area in relation to their body mass, leading to a greater heat loss. They also lack the shivering mechanism that generates heat in older children and adults. However, they do possess brown adipose tissue, which helps produce heat, although this resource is quickly depleted if not protected by a warm environment.

To support temperature regulation in newborns, caregivers should create a thermally stable environment through skin-to-skin contact, swaddling, using hats or warm blankets, and keeping the infant in a room with a controlled temperature. In clinical settings, devices like radiant warmers or incubators are used to provide an ideal thermal environment for those at risk of hypothermia, ensuring their precious energy is used for growth and development rather than just keeping warm.