A newborn is a small wet body with a large surface area, thin fat, no shiver and no way to put on a sweater. Find all four routes of heat loss in the room and name the countermeasure for each, drive a temperature down the cold-stress cascade and watch glucose and acid follow it, then work the hypoglycaemia thresholds by hour of life with every line of the dose arithmetic shown.
Work the thermal problem
Every item in this birthing room is taking heat off a newborn. Select each one, name the route it uses, and collect all four.
Evaporation—
Conduction—
Convection—
Radiation—
36.8 °C
Normal newborn axillary temperature is 36.5 to 37.5 °C (97.7 to 99.5 °F). Drag the temperature down and watch the chain fire in order.
Who is this newborn?
Newborns cannot shiver effectively. They make heat by non-shivering thermogenesis in brown adipose tissue, deposited from about 26 to 30 weeks in the interscapular region, around the neck, in the axillae, in the mediastinum and around the kidneys and adrenals.
Thresholds vary between guidelines and units; follow the protocol where you work. The operational floor most units use in the first 24 to 48 hours is a plasma glucose of 45 mg/dL.
Four routes, four countermeasuresEvaporation dominates the first minutes of life
Select something in the room
Each object loses heat by a specific route, and each route has a specific countermeasure.
Neutral thermal environmentMinimal oxygen consumption, minimal metabolic work
Brown fat being burned0
Oxygen consumption0
Glucose consumption0
Lactic acid / acidosis0
Free (unbound) bilirubin0
Within the normal band
Screen, then decideTreat first and send the confirmatory sample second