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Continuing Care. Mary P. Martinasek, RRT Director of Clinical Education Hillsborough Community College. Homeostatic Thermoregulation. Defined as the maintenance of equality between: Heat dissipation and heat production Core body temp of 37 degrees C. Heat Production.

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Continuing care

Continuing Care

Mary P. Martinasek, RRT

Director of Clinical Education

Hillsborough Community College

Homeostatic thermoregulation
Homeostatic Thermoregulation

  • Defined as the maintenance of equality between:

  • Heat dissipation and heat production

  • Core body temp of 37 degrees C

Heat production
Heat Production

  • Adult - can be produced by metabolic and physical activity (shivering)

  • Infant - has diminished shivering response and relies on metabolism of brown fat for heat production.

    • The breakdown of brown fat is called nonshivering thermogenesis

Methods of heat loss
Methods of Heat Loss

  • Radiant

  • Conductive

  • Convective (ambu bag air blowing on pt.)

  • Evaporative

Goal of thermoregulation
Goal of Thermoregulation

  • Maintain an environmental temperature such that the neonate’s core body temperature is maintained between 36.5 and 37.5 degrees C


  • Incubator

    • Controlled environment (less convective heat loss)

    • Barrier to excessive handling

    • Quieter environment

  • Radiant Warmer (open bed)

    • Easier patient access (critical care)

    • Easier to attach probes and electrodes

Fluid and electrolyte balance
Fluid and Electrolyte Balance

  • Distribution of Body Water

    • 80% of total body weight of term infant

    • Decreases with aging

  • Distribution of Solutes

  • Fluid Deficit

    • Anterior fontanelles

  • Electrolyte Balance

Distribution of solutes



















Distribution of Solutes

Insensible water loss
Insensible Water Loss

  • IWL - water lost by evaporation from the skin and respiratory tract

  • Factors that increase insensible water loss

    • Premie

    • Respiratory distress

    • High environmental temperature

    • High body temperature

    • Break in skin

    • Radiant warmer

    • Phototherapy

    • Increased activity

Neonatal jaundice
Neonatal Jaundice

  • Physiologic vs. Pathologic

    • Physiologic is common (25-50% of all newborns)

    • Pathologic

      • Caused by RH or ABO incompatibility

      • Bacterial or viral infections

      • Hemorrhaging in fetal body

      • IDM

      • Breast fed infants

      • Determined to be pathologic by certain criteria

Exchange transfusion
Exchange Transfusion

  • Used in an attempt to rid the neonatal body of factors causing hemolysis

  • Replaces about 87% of patient’s blood volume

  • Corrects severe anemia

  • Treats hemolytic disease by removing antibody-coated RBC

  • Removes excessive amounts of unconjugated bilirubin

Necrotizing enterocolitis nec
Necrotizing Enterocolitis (NEC)

  • Idiopathic disorder characterized by ischemia and necrosis of the intestine

  • Etiological Factors include:

    • Mucosal wall injury

    • Bacterial invasion into the damaged intestinal wall

    • Formula in the intestine

Clinical signs and treatment
Clinical Signs and Treatment

  • Guaiac-positive stools (presence of blood)

  • Poorly tolerated feedings

  • Abdominal distension

  • Bile residuals

  • Signs of sepsis (lethargy and increased O2 requirements)

  • Tx= avoid factors that lead to presence