Thermoregulation is defined as the ability to maintain a balance between heat controlling and heat loss to maintain the body temperature normal. However, newborns cannot regulate their body temperature so they will experience stress due to changes in the environment. When the baby is born, it enters a colder external environment. This cold temperature causes the amniotic fluid to evaporate through the skin, so it cools the baby’s blood. In a cold environment, the formation of temperature without a shivering mechanism is the main effort of a cold baby to regain body heat. This is the result of using chocolate fat throughout the body, and they can increase body heat to 100%.
To burn brown fat, a baby must use glucose to get the energy that will turn fat into heat. Brown fat cannot be reproduced by newborns. The brown fat reserves will run out in a short time with stress due to cold temperatures. The longer the gestational age, the more supplies of baby brown fat. If babies feel cold, they will begin to experience hypoglycemia, hypoxia, and acidosis. Therefore, prevention of heat loss is a crucial priority. Here, the health workers are obliged to minimize heat loss in newborns. It is called as hypothermia if the body temperature drops below 36˚C. The normal temperature in neonates is 36.5 – 37.0 ˚C.
Newborns are easily exposed to hypothermia caused by:
- The important and perfect for regulating body temperature in infants has not functioned perfectly.
- The baby’s body surface is relatively wider.
- The baby’s body is too small to produce and store heat.
- The baby has not been able to arrange possession of his body and clothes.
Hypothermia can occur at any time when the temperature around the baby is low. It also can occur of the efforts to maintain body temperature are not applied appropriately, especially during the stabilization period of the first 6-12 hours after birth. For example, the newborn is left wet and naked while waiting for the placenta to be born. Even though the environment around the baby is warm enough the baby is left naked or immediately bathed.
Here are several symptoms of hypothermia:
- In line with the decrease in body temperature, the baby becomes less active, lethargic, hypotonic, weak enough to suck milk even crying weakly.
- Breathing getting gasps and slow and the heart rate decreases.
- Sclerema arises: the skin hardens reddish, especially in the back, legs, and arms.
- The baby’s face is bright red
- Hypothermia causes changes in the body’s metabolism which will end with the failure of heart function, bleeding especially in the lungs, jaundice, and death.
There are four mechanisms for possible loss of body heat from newborn babies.
It is defined as the transfer of heat from the baby’s body to other objects through direct contact. It functions to weigh the baby without a scale, then the cold health workers’ hands holding the newborn baby, and using a cold stethoscope for the examination of the newborn.
Heat is lost from the baby into the surrounding moving air (the number of amount of heat lost depends on the speed and temperature of the air). An example of a baby’s body heat convection is to leave or place a newborn near the window, leaving the newborn in the room with the fan.
The heat emitted from a newborn baby releases the body in a cooler environment. In short, it is defined as heat transfer between two different temperatures objects. For examples, newborns left in a room with unheated air conditioners, left naked, sleeping next to a cold room such near the wall.
Heat is lost through the evaporation process depending on the speed and humidity of the air (heat transfer by changing the liquid to combine steam). Evaporation is influenced by the amount of heat used by the level of air humidity. The flow of air that passes when the newborn is left to room temperature of 250C, then the baby will lose heat through convection, radiation, and evaporation of 200 kilograms of body weight.
To prevent heat loss in newborns, you can try to dry the baby carefully. In bathing, prepare a warm environment, then wash and dry every part of the body to reduce evaporation, cover the baby with a blanket or cloth clean, dry and warm, close the baby’s head. Further, try to encourage the mother to hug and suck the baby.
The effects that can be caused by hypothermia are:
- Hypoglycemia metabolic acidosis, due to peripheral vasoconstriction with anaerobic metabolism.
- Increased oxygen requirements.
- Metabolism increases so that growth is disrupted.
- Clotting disorders resulting in accompanying pulmonary bleeding heavy hypothermia.
- Intra Ventricular Bleeding. Hypothermic Prevention and Treatment The sudden administration of heat is dangerous because it can occur apnea so it is recommended to warm up 0.5 – 1 ° C per hour (in infants <1000 grams maximum heating of 0.6 ° C)
To function optimally, the brain requires glucose in a certain amount. By clamping the cord with a clamp at birth a baby must begin to maintain his blood glucose level. In each newborn, blood glucose will drop quickly (1 to 2 hours).
Correction of decreased blood sugar levels can be done in 3 ways:
- through the use of breast milk
- through the use of glycogen reserves
- through making glucose from other sources, especially fat.
Newborns who are not able to digest enough food will make glucose from glycogen (glycogenization). This only happens if the baby has sufficient stock of glycogen. A healthy baby will store glucose in the form of glycogen, especially in the liver, during the last months in the uterus.
Babies who experience hypothermia at birth results in hypoxia. They will use glycogen reserves in the first hours of birth. Glucose balance is not fully achieved in the first 3-4 hours of birth in term infants. If all supplies of glycogen are used in the first hour, then the brain is potentially getting risk. Further, premature births, post-maturity, infants with barriers to growth in the uterus even fetal stress are having the main risks since energy stores are reduced (used gradually before birth).
Symptoms of hypoglycemia can be unclear and not typical, including; subtle seizures, cyanosis, apnea, weak crying, lethargy, weakness and refusing food. Hypoglycemia can also be asymptomatic at first. The long-term result of hypoglycemia is widespread damage throughout the brain cells.