Neonatal Hypothermia Nursing Diagnosis and Nursing Care Plan

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Neonatal Hypothermia Nursing Care Plans Diagnosis and Interventions

Neonatal Hypothermia NCLEX Review and Nursing Care Plans

Neonatal hypothermia is a pathological condition in which a baby’s temperature falls below the usual temperature limits.

However, there is no consensus in the literature as to what constitutes a conventional accepted normal temperature range, with varying values reported in different research.

Because there is no universally accepted normal temperature, many authors accept a range of temperatures as “normal,” with neonatal norms ranging from 36 to 37.7°C, depending on the study’s geographical location and environmental/seasonal factors.

The World Health Organization (WHO) recommendations are used to characterize the ‘normal’ ranges of infant normothermia and hypothermia in the absence of agreement among researchers. A baby is considered normothermic when its temperature is between 36.5 and 37.5°C, and hypothermic when it is below the temperature range specified above.

WHO has split hypothermia into three distinct categories to make diagnosis and treatment easier:

  • Mild neonatal hypothermia occurs when the temperature falls between 36 and 36.4°C.
  • Moderate neonatal hypothermia happens in temperatures between 32 and 35.9°C
  • Severe hypothermia is defined as a temperature below 32°C.

Hypothermia in babies must be treated immediately to avoid serious and potentially fatal consequences.

As the infant struggles to stay warm, cellular metabolism increases, resulting in increased oxygen consumption, putting the baby at danger of hypoxia, cardiorespiratory problems, and acidosis. These babies are likewise vulnerable.

Because of the increased glucose consumption required for heat production, there is a risk of hypoglycemia.

If untreated hypothermia worsens, neurological problems, hyperbilirubinemia, coagulation abnormalities, and even death may occur.

Signs and Symptoms of Neonatal Hypothermia

  • Acrocyanosis and skin that is cold, mottled, or pale
  • Low blood sugar
  • Temporary hyperglycemia
  • Atrial fibrillation
  • Tachypnea, agitation, and shallow, irregular breathing
  • Apnea, hypoxia, metabolic acidosis, respiratory distress
  • Inactivity, lethargy, and hypotonia
  • Poor eating and a weak cry
  • Reduced weight gain

Causes of Neonatal Hypothermia

  • Low birth weight and premature birth. Hypothermia is most likely to occur in babies born before 28 weeks of pregnancy.
  • Cold birth environment. Many babies, including full-term babies, are born with a body temperature that is close to hypothermic. The baby’s body temperature can swiftly decrease if born in a cold environment.
  • Hypoglycemia
  • Infection
  • Meningitis is a condition in which the membranes that surround the spinal cord become inflamed. It can produce a fever in babies in some situations, but it can also cause a lower-than-normal body temperature in others.

  • Sepsis, a deadly bacterial infection of the blood, frequently have a low body temperature. It may alternatively cause a fever in some circumstances.

Risk Factors for Neonatal Hypothermia

Neonatal hypothermia is linked to a variety of risk factors that are divided into four categories:

  1. Physiological. Prematurity, low birth weight, and intrauterine growth restriction are all examples of physiological risk factors in neonates. Hypothermia is more likely in babies who are “small for dates” or hypoglycemic.
  2. Behavioral. Any non-evidence-based actions, often done for cultural reasons, that may induce a drop in the baby’s temperature, resulting in hypothermia, are considered behavioral risk factors. Bathing the baby shortly after birth and/or massaging the baby with essential oils after birth are two common actions that may contribute to neonatal hypothermia.
  3. Environmental. The geographical place in which the infant is born, as well as the time of year or seasons and room temperature at the moment of birth are all environmental risk factors.
  4. Socioeconomic. Socially, babies born to low-income households and/or countries with limited resources are more likely to be socially and economically disadvantaged. Because health practitioners in resource-poor nations may lack expertise, best available evidence, and other resources to support best practice, babies born in these countries are at risk of neonatal hypothermia.

Complications of Neonatal Hypothermia

  • Hypoglycemia. This is the most prevalent cause of death in hypothermic babies and the most serious hypothermia complication. In order to stay warm, cold babies expend a lot of energy. As a result, the energy reserves get exhausted, leading to hypoglycemia.
  • Hypoxia. When hemoglobin becomes cold it absorbs oxygen but will not release it. The oxygen is then not released to the body cells and gets trapped in the hemoglobins`. The cold baby, therefore, appears centrally pink even while dying of hypoxia. Hypothermia also increases the oxygen needs of the body and this make the hypoxia worse.
  • Metabolic acidosis. Blood does not carry enough oxygen to the cells due to insufficient peripheral perfusion. As a result of the hypoxia, a metabolic acidosis develops.

Diagnosis for Neonatal Hypothermia

  1. Measuring the body temperature. WHO recommends that neonatal temperatures be taken at the axilla and that rectal temperatures be taken only if there is a diagnosis of neonatal hypothermia. The skin temperature of an infant is frequently taken rather than the oral or rectal temperature. Because infants are more likely to become cold than hot, measuring axillary (armpit) or belly skin temperature is ideal because the skin is the first area of the body to cool down.

Skin temperature can be determined using the following methods:

  • Digital thermometer. It is placed in the axilla (armpit) of the infant for two minutes before the reading is taken. When not in use, thermometers should be kept dry to avoid cross-infection.
  • Telethermometer. Also known as electrical thermometer, the probe of a telethermometer is commonly positioned over the left, lower abdomen, or lower back. Avoid the right upper abdomen since the liver produces a lot of heat, which might cause a reading to be overly high. Regular calibration of telethermometers is recommended.

Prevention of Neonatal Hypothermia

  1. Follow the warm chain. A set of interconnected operations that should be undertaken before birth, as well as in the hours and days after birth, to reduce heat loss in all babies mandated by WHO. If any of these protocols are not followed, the chain will be broken, putting the baby at risk of getting cold

The ten steps of the warm chain include:

  1. Warm delivery room
  2. Immediate drying
  3. Skin-to-skin contact
  4. Breastfeeding
  5. Postpone weighing and bathing
  6. Appropriate clothing/blanket
  7. Mother and baby together
  8. Warm transportation
  9. Warm assessment (if baby not skin-to-skin with mother)
  10. Training and raising awareness

2. Identify who is at risk. All infants at high risk of hypothermia should be identified. All babies who are likely to produce too little or lose too much heat are included.

3. Provide an appropriate amount of food for energy. Oral, nasogastric tube, or intravenous feeding can be used to provide energy (calories). This is especially significant in infants who have minimal brown and white fat at birth. By providing the baby with the energy needed to produce heat, early feeding with breast milk or milk formula feeds helps to prevent the occurrence of hypothermia.

4. Insulate the baby. Use a woolen cap and dress the baby. Because the surface area of the scalp is big, the brain produces a lot of heat, and there is little hair for insulation, the baby infant’s head loses a lot of heat by radiation. Booties or leggings are less effective than a woolen cap. If the baby is receiving headbox oxygen that has not been warmed, a woolen cap is very important. Woolen caps should be worn by most infants in incubators.

5. Dry the baby. All wet babies should be dried right away and wrapped in a warm, dry towel. Do not leave a wet towel on the baby. Always remember to dry the baby’s head.

6. Treat any infection or hypoxia. All babies who are at risk of hypothermia should have their skin or axillary temperature monitored. Any drop in temperature must be detected as soon as possible.

Treatment for Neonatal Hypothermia

  1. Mild hypothermia (36.3°C body temperature)
    • Skin-to-skin contact should be done in a warm room with at least 25°C
    • Put a hat on the baby’s head.
    • Wrap the mother and the baby in warm blankets.
  1. Moderate hypothermia (34.9°C body temperature)
    • Near a radiant heat source
    • Incubate in a warm environment
    • In a water-filled heated mattress
    • If there is no equipment or if the baby is clinically healthy skin-to-skin contact with the mother can be employed if it is stable in a warm (at least 25°C) environment.
  1. Severe hypothermia (body temperature is less than 32°C)
    • Using a heated incubator set to 1 to 1.5 degrees Celsius which a temperature that is higher than the body temperature and should be adjusted with the temperature of the baby.
    • If no equipment is available, skin-to-skin contact or a warm room or a cot can be utilized.

Neonatal Hypothermia Nursing Diagnosis

Neonatal Hypothermia Nursing Care Plan 1

Hypothermia

Nursing Diagnosis: Hypothermia related to the inability to manage thermoregulation due to a lack of subcutaneous thermoregulator secondary to preterm birth, as evidenced by acrocyanosis, skin cold to touch , and temperature of 35°C.

Desired Outcomes:

  • The patient’s body temperature will progressively recover to normal limits as evidenced by an increase in temperature from 35°C to 36.5°C.
  • The patient will be free from hypothermia.
Nursing Interventions for Neonatal HypothermiaRationale
Adjust the temperature of the environment and provide a comfortable and warm delivery room with all the supplies prepared and warmed ahead of time.  The delivery room should be at least 25°C and free of contaminant drafts coming in through open windows, doors, or fans. Adults should never choose the temperature of the delivery room according to their personal preferences. These techniques allow for a more progressive bodily warming and prevent evaporative heat loss.
Warm the patient immediately after birth, allow skin-to-skin contact with the mother and keep covered and provide a cap on the baby’s head and cover the body with a second towel.Warming a cold baby with skin-to-skin contact is effective and putting a cap on the head prevents heat loss from convection  
Provide energy to the patient while being warmed  During the warming process, hypoglycemia can occur. Oral or nasogastric milk, or an intravenous maintenance fluid containing 10% dextrose water, can be used to provide energy for the baby.
Provide an immediate drying of the patient after birth.To reduce heat loss from evaporation, dry the baby as soon as possible after birth with a warm towel or cloth.
Allow a transition period of 6-8 hours before bathing the patient and postpone weighing until uninterrupted skin-to-skin contact is done.  Weighing can be done after the first meal and the period of uninterrupted skin-to-skin contact. Put a cover the scale using a warm blanket. Bathing a baby immediately after birth lowers the body temperature, potentially causing hypothermia and hypoglycemia.
Assess the patient for other potential triggers and risk factors of hypothermia.The right treatment is guided by the causal variables and identifying the triggers will help in alleviating the condition.
Monitor the patient’s body temperature, Keep track of the patient’s heart rate, and cardiac rhythm.A digital thermometer can be used to monitor the core axillary temperature in hypothermic patients. As hypothermia advances, the heart rate and blood pressure decrease. Hypothermia, especially moderate to severe hypothermia, raises the risk of atrial fibrillation and other arrhythmias.
Assess the nutrition and weight of the patient.  Poor weight depletes energy reserves and limits the body’s ability to create heat through calorie intake.

Neonatal Hypothermia Nursing Care Plan 2

Failure to Thrive

Nursing Diagnosis:  Failure to Thrive related to congenital digestive system disorders secondary to preterm birth, as evidenced by poor sucking, a weak cry, and altered measurement of weight, height , and head circumference.

Desired Outcomes:

  • The patient will be able to achieve the ideal weight and height appropriate for age.
  • All nutritional deficiencies of the patient will be corrected.
Nursing Interventions for Neonatal HypothermiaRationale
Assess the patient’s height and weight, and medical history and determine the results of diagnostic tests as advised.The results of the initial assessment and laboratory findings will be the basis of the possible intervention and requirement for further evaluation.
Ask the mother about the patient’s feeding status, the frequency and amount of feeding, whether breastfed or formula, and the behavior while feeding.This will be the baseline data to determine the appropriate intervention.
Evaluate the patient’s status with the use of a growth chart and daily weight chart and advise the mother to make a food diary,Regular checking of weight is one of the interventions to correlate the food intake to the weight gain.
Educate the mother or family on how to address the nutrient deficiency and identify poor feeding habits to be eliminated.To provide specific feeding guidelines and correct misinformation.
Advised the patient’s mother or family to strictly adhere to the dietary guidelines prescribed by the nutritionist.Being consistent and diligently following the treatment plan will help in achieving the patient’s recovering state.

Neonatal Hypothermia Nursing Care Plan 3

 Impaired Comfort

Nursing Diagnosis: Impaired Comfort related to an inability to tolerate cold environment secondary to preterm birth, as evidenced by unstoppable crying, inability to sleep and restlessness.

Desired Outcome: The patient will be able to demonstrate signs of improved comfort.

Nursing Interventions for Neonatal HypothermiaRationale
Assess a number of potential sources of discomfort and establish a baseline for each.    Many factors could make the baby uncomfortable, especially if in the hospital. Getting a baseline is an excellent place to start for healthcare professionals looking to improve the patient’s level of comfort.
Create a conducive and warm environment that will make the patient more comfortable and promote sleep, provide a warm light if necessary.  Using a white noise machine, reduced environmental stimulation and adjusted room temperature will make it suitable for the baby’s temperature regulation and will help comfort the baby.  
Determine if the patient has a wet or dirty diaper, change the diaper if necessary and dry the patient.Wet or dirty diapers will make the baby uncomfortable and feel cold.
Insulate the patient with proper clothing that is comfortable and will promote warmth without overheating the patient.  The baby can be kept warm by wrapping the body in an insulating layer that is appropriate to the temperature of the room, reducing heat loss through convection and radiation to cold things in the room. The baby is dressed in a nappy, jacket, woolen cap, and booties. A woolen cap is essential for avoiding heat loss through radiation. Babies in closed incubators are frequently clothed.
Burp the infant after each feeding.    Feeding might cause air to get trapped in the baby’s stomach, making the baby uncomfortable and fussy.
Allow the patient to absorb maternal body heat and bond with the mother by skin-to-skin contact.By placing the baby near the mother’s bare chest, the baby can be kept warm and comfortable quickly. A woolly cap and nappies should be worn by the baby. Both the mother and the baby should be covered. The baby will be kept warm by the mother’s body heat. Kangaroo mother care begins with this simple technique (KMC).
Swaddle the patient and educate the significant other about the purpose of swaddling.Some people believe that wrapping a blanket over a baby is done for warmth, while others believe it is done for comfort. But the main reason for swaddling is that it helps reduce the startle reflex, preventing babies from waking themselves up.

Neonatal Hypothermia Nursing Care Plan 4

            Risk for Ineffective Tissue Perfusion

Nursing Diagnosis: Risk for Iineffective Tissue Perfusion related to decreased peripheral blood flow secondary to preterm birth.

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Desired Outcomes:

  • The patient will no longer display worsening or repetition of the deficit.
  • The patient will be able to maintain adequate tissue perfusion as evidenced by warm skin, vital signs within the normal limits , and balanced intake and output.
Nursing Interventions for Neonatal HypothermiaRationale
Assess the patient for symptoms of poor tissue perfusion.    Different reasons create different clusters of signs and symptoms. The defining aspects of ineffective tissue perfusion are evaluated to give a baseline for future comparison.
Check the patient’s breathing pattern and determine the presence of labored breathing.  Respiratory distress can be caused by cardiac pump failure and/or ischemic pain. However, sudden or persistent dyspnea could indicate thromboembolic pulmonary consequences.
Assess the patient for any sudden or persistent changes in the neurological state.  Cerebral perfusion is influenced by electrolyte/acid-base changes, hypoxia, and systemic emboli. It also has a direct relationship with cardiac output.
Assess the patient’s gastro-intestinal functions including presence or absence of bowel sounds, nausea or vomiting, abdominal distension, and constipation.Reduced blood supply to the mesentery can result in GI dysfunction, such as loss of peristalsis.
Monitor the patient’s oxygen saturation and pulse rate with pulse oximetry.Pulse oximetry is a helpful method for detecting oxygenation changes.
Check the patient’s hemoglobin levels  Low levels limit oxygen uptake and delivery to the tissues at the alveolar-capillary barrier.
Assess the patient for pallor, cyanosis, mottling, and cold or clammy skin, and determine the quality of the pulse.    The absence of peripheral pulses must be immediately reported or handled. Reduced cardiac output can cause systemic vasoconstriction, which can cause decreased cutaneous perfusion and pulse loss. As a result, assessment is required for constant monitoring.
Monitor the patient’s intake by the number of feeding and urine output. As needed, determine the urine-specific gravity.  Reduced intake can lead to a reduction in circulation volume, which has a great impact on perfusion and organ performance. Specific gravity measurements reflect hydration state and renal function.

Neonatal Hypothermia Nursing Care Plan 5

            Risk for Infection

Nursing Diagnosis: Risk for Infection related to immunosuppression secondary to preterm birth.

Desired Outcomes:

  • The patient will be able to remain free from any signs of infection.
  • The significant other will be able to determine signs of infection and apply effective techniques on managing the symptoms.
Nursing Interventions for Neonatal HypothermiaRationale
Assess the patient’s overall health status, determine the baseline vital signs.  Allows the health care provider to determine the necessity for intervention and the therapeutic effectiveness.
Ensure that the patient’s equipment and supplies are sterile and clean. Avoid using the same equipment as other patients.Prevents germs from spreading to the patient through equipment used with another patient.  
Assess the patient’s skin color, texture, moisture and elasticity.    The prevention of skin breakdown, which is the body’s first line of defense against infections, is made easier with proper skin examination and documentation.
Check the patient’s white blood cell count, serum protein, and serum albumin on a regular basis.These lab results are linked to the patient’s nutritional state and immune system performance.
Monitor the patient for any indicators of swelling or purulent discharge,These are some of the typical symptoms of infection.
Encourage the mother or family to wash their hands before and after touching the patient.  Handwashing is an efficient method of preventing infection spread. Dry surfaces are superior at avoiding microorganism translocation.
Limit the quantity of the patient’s visitors and advise the mother to avoid people who are sick from visiting the patient.This is to reduce the risk of pathogen exposure to the patient and if the baby is at higher risk, avoid contact with other adults and children who have cold-like symptoms or who have had a stomach upset, as the illness can be contagious.
Educate the mother or guardian about the possible transmission of different diseases, complications and how to get help when symptoms arise.Proper education will raise the understanding of the risks and sticking to the guidelines.

Nursing References

Ackley, B. J., Ladwig, G. B., Makic, M. B., Martinez-Kratz, M. R., & Zanotti, M. (2020). Nursing diagnoses handbook: An evidence-based guide to planning care. St. Louis, MO: Elsevier.  Buy on Amazon

Gulanick, M., & Myers, J. L. (2022). Nursing care plans: Diagnoses, interventions, & outcomes. St. Louis, MO: Elsevier. Buy on Amazon

Ignatavicius, D. D., Workman, M. L., Rebar, C. R., & Heimgartner, N. M. (2020). Medical-surgical nursing: Concepts for interprofessional collaborative care. St. Louis, MO: Elsevier.  Buy on Amazon

Silvestri, L. A. (2020). Saunders comprehensive review for the NCLEX-RN examination. St. Louis, MO: Elsevier.  Buy on Amazon

Disclaimer:

Please follow your facilities guidelines, policies, and procedures.

The medical information on this site is provided as an information resource only and is not to be used or relied on for any diagnostic or treatment purposes.

This information is intended to be nursing education and should not be used as a substitute for professional diagnosis and treatment.

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