Neonatal Care: Thermoregulation

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Define and describe the temperature stabilization and regulation of the normal neonate including

In neonatal care, thermoregulation is critical since it allows preventing hypothermia in infants, particularly, premature ones. Therefore, the process of temperature stabilization and regulation plays a critical role in the management of an infant’s needs (Knobel-Dail, 2014).

The difference between intrauterine and extrauterine thermal environments

To provide care of the proper quality, one should keep in mind the difference between intrauterine and extrauterine thermal environments. While the former is self-regulating in a healthy pregnant woman and, therefore, implies consistent temperature, the latter may involve significant shifts in temperature, which may cause thermal issues. Specifically, the extrauterine environment is expected to have a lower temperature than the intrauterine one (Knobel-Dail, 2014). Therefore, temperature stabilization in the extrauterine environment implies the use of oxygenation to stimulate nonshivering thermogenesis (NST). Controlling temperature in the intrauterine environment can be performed via enhancement of umbilical circulation.

The neutral thermal environment

The neutral thermal environment (NTE) is typically seen as the ultimate goal of managing the needs of newborn babies. Therefore, NTE does not require any thermoregulation and only has to be sustained (Knobel-Dail, 2014). Thus, one can ensure a proper metabolic rate in newborn babies.

Hypothermia

A low-temperature setting may entail hypothermia in infants, which is extraordinarily dangerous for their well-being. Therefore, rewarming hypothermal infants and increasing the temperature levels in the delivery room should be regarded as critical steps toward the improvement of their well-being (Knobel-Dail, 2014). Thus, rewarming the incubator in which an infant is contained has to be seen as a necessary measure.

Hyperthermia

Being just as dangerous to a newborn baby as hypothermia, if not more so, hyperthermia also needs to be addressed by introducing thermoregulation into the incubation room. Preventing exposure to direct sunlight is also a critical step toward reducing the side effects of high temperatures in newborn babies (Adams-Chapman, Carlton, & Moore, 2015). The described measures are expected to lead to a positive outcome in infants with temperature-related issues.

The role of the hypothalamus, thyroid, and adrenal glands

While typically being associated with the endocrine functions of the human body, the hypothalamus, thyroid, and adrenal glands also affect the process of temperature regulation in infants. The thyroid axis defines the development of adaptive thermogenesis in newborns due to the enhancement of metabolic rate (Knobel-Dail, 2014). In turn, the hypothalamus is also linked to the process since the specified part of the human brain releases the chemicals that stimulate the functioning of the thyroid gland (Adams-Chapman et al., 2015). Finally, prompting adrenergic interactions, adrenal glands contribute to the development of thermoregulation in infants (Knobel-Dail, 2014).

Brown adipose

In addition to the functions that enhance metabolism, the body of an infant produces the substance known as brown adipose, or brown fat (Adams-Chapman et al., 2015).. The brown adipose tissue allows producing extra heat, which is further stimulated by breastfeeding (Knobel-Dail, 2014). As a result, the threat of hypothermia in infants is reduced.

Shivering

Representing a natural reaction to a drop in temperature, the specified phenomenon also serves as the natural protection against the threat of hypothermia in infants.

The four mechanisms of heat loss, and their prevention

When addressing the phenomenon of heat loss, four types thereof are typically listed. These are radiation, convection, conduction, and evaporation. The names of the phenomena under analysis are self-explanatory. Reducing exposure to dry air should help address evaporation, while the problem of radiation can be managed by keeping an infant away from cold objects. Conduction implies that the objects coming in contact with an infant’s skin should be removed to prevent heat loss. To manage convection, one should cover an infant with a blanket.

Discuss the effect of hypothermia (cold stress) and hyperthermia, both acute and chronic, on

Glucose metabolism

Hypothermia has a deplorable effect on infants’ well-being due to exposure to a vast range of health risks. Due to the slowdown in the biological processes within an infant’s body during hypothermia, the production of glucose and its metabolism, in general, are slackened significantly. The described outcome has a directly negative impact on a child.

O2 consumption

Similarly, O2 consumption becomes significantly slower during hypothermia, which can lead to brain damage in infants. The described outcome is particularly dangerous to infants since it may lead to stunted development (Adams-Chapman et al., 2015). Thus, addressing hypothermia should be the priority during thermoregulation in neonatal care.

Blood pH

Hypothermia in newborns also implies a drop in their blood pH levels. As a result, the threat of acidosis becomes very tangible for newborn children. For this reason, hypothermia should be prevented at an early stage.

Respirations

Finally, the progression of hypothermia in newborn children may cause respiratory difficulties. Shallow and irregular respiration is very characteristic of hypothermia in newborns (Nowack, Giroud, Arnold, & Ruf). Therefore, a drop in temperature will entail respiratory difficulties that may cause irreparable damage to infants.

Describe three ways a neonate can create heat

As a result, three key ways in which a neonatal can create heat are identified. These include natural responses to a change in temperature and include shivering, thermogenesis without shivering, and the development of voluntary muscle activity caused by the intuitive need to keep warm (Adams-Chapman et al., 2015). The phenomenon of nonshivering thermogenesis as one of the more complicated processes involves the use of brown adipose tissue (Adams-Chapman et al., 2015). Alternatively, the described function is performed through increased metabolic processes (Nowack et al., 2017). Consequently, a rise in body temperature is observed. The presence of two pathways in the creation of the environment for increased body heat is one of the unique properties of the nonshivering thermogenesis phenomenon.

Shivering, in turn, is significantly less efficient than the other two methods. The described method implies a response to a drop in temperature and occurs in instances that imply a severe change in temperature (Knobel-Dail, 2014). Overall, the specified response signals that a newborn requires immediate assistance.

Finally, involuntary muscle contraction offers mixed results. While producing a significantly better effect than shivering, it does not allow keeping the body temperature at the necessary rate. Therefore, the production of brown fat can be seen as the most effective response toward a change in temperature. Nevertheless, the presence of the specified responses toward a drop in temperature does not negate the importance of timely neonatal care.

Describe the signs in the neonate indicating problems with thermogenesis

Locating problems with thermogenesis in infants is critical to the management of their health needs. In the target demographic, the presence of symptoms such as the central temperature being 36.4°C or less, change in the core-toe gap (2° or more), change in the skin tone (pale or molted), increased need for oxygen, and the signs of acidosis (Nowack et al., 2017). Similarly, the presence of tachycardia can be regarded as an important symptom of thermoregulation issues (Adams-Chapman et al., 2015). Once identified, the described problems require immediate management.

Describe prenatal and intrapartal factors that contribute to thermogenic problems

There are a plethora of factors that may induce temperature regulation issues in neonates. For example, maternal intrapartum fever may cause problems in newborns’ thermoregulation (Knobel-Dail, 2014). Similarly, the heat generated by the contracting uterus may cause difficulties in infants controlling their body temperature (Knobel-Dail, 2014). However, the connection between thermoregulation issues in infants and epidural analgesia provided to mothers remains questionable (Knobel-Dail, 2014). Among prenatal factors that may induce thermogenic issues, one has to mention the under- or overheating of the incubator (Nowack et al., 2017). By controlling the external issues and managing intrapartum concerns, one will be able to prevent thermogenic problems in infants.

References

Adams-Chapman, I., Carlton, D. P., & Moore, J. E. (2015). McGraw-Hill Specialty Board Review neonatal-perinatal medicine. New York, NY: McGraw Hill Professional.

Knobel-Dail, R. B. (2014). Role of effective thermoregulation in premature neonates. Research and Reports in Neonatology, 4, 147-156. Web.

Nowack, J., Giroud, S., Arnold, W., & Ruf, T. (2017). Muscle non-shivering thermogenesis and its role in the evolution of endothermy. Frontiers in Physiology, 8(889), 1-13. Web.

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