question archive Client Profile Baby Ethan was born via a normal spontaneous vaginal delivery (NSVD) at 36 weeks gestation
Client Profile Baby Ethan was born via a normal spontaneous vaginal delivery (NSVD) at 36 weeks gestation
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Client Profile
Baby Ethan was born via a normal spontaneous vaginal delivery (NSVD) at 36 weeks gestation. The mother arrived at the emergency room dilated to 9 centimeters and 100 % effaced. The mother also reports ruptured membranes for the past 22 hours. The fetal heart rate upon admittance to the emergency room is 170 bpm. The mother delivered in the emergency room 30 minutes after being examined. This is her seventh pregnancy, and she did not have prenatal care.
Case Study
Ethan was admitted to the observation nursery from the emergency room where he was born. He weighed 5 pounds and was 19 inches long. His APGAR scores were 6 at one minute, and 8 at five minutes. Points were initially taken off for tone, reflexes, and color. His initial glucose was 35 and vital signs were heart rate 150, respirations 76, and temperature 97.2. The nurse noted some nasal flaring, grunting, and coarse breath sounds. He was given 1 ounce of D5W orally; oxygen therapy, and his skin and pharynx were cultured. The orders also included that he be placed on a warmer with skin probe for temperature monitoring.
At two hours the baby's glucose was 40, the nasal flaring continued, respiratory rate was 100 with continued coarse breath sounds. He exhibited acrocyanosis, and his temperature was 96.8. The baby was treated for transient tachypnea of the newborn with oxygen therapy and a warm environment.
At four hours the nurse noted that the baby was lethargic and difficult to arouse. He appeared pale with circumoral cyanosis, nasal flaring, and grunting with sternal retractions. The nurse notified the doctor, an IV was started, and the baby was transferred to the neonatal intensive care unit at a hospital in the next town.
At six hours the mother called the NICU to check on his progress and was told that he had subsequently developed jaundice and was on a ventilator.
1) Why is baby Ethan hypothermic, and how does it affect his transition?
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Neonatal Hypothermia can occur to newborn because of many factors. Heat loss may occur due to:
- Radiant heat loss - the newborn's skin is exposed to objects with lower temperature
- Evaporative heat loss - when the amniotic fluid in the newborn's skin evaporates, this heat loss may occur
- Conductive heat loss - when the neonates are placed in a cold surface
- Covective heat loss - the flow of cold air may affect the temperature of the newborn
Since baby Ethan is a preterm infant (born before 37 weeks of gestation) and has a low birth weight (5lbs) , he has less subcutaneous fat to protect him from hypothermia. Newborn like baby Ethan, responds to the hypothermia by utilizing its "brown fats" to produce heat. Utilizing too much brown fats may increase lactic acid production and may result in metabolic acidocis, hence the symptoms like lethargy, jaundice, nasal flaring and grunting with sternal retractions.
During hypothermia, the oxygen demand in the baby Ethan's body is increased while the oxygen carrying capacity of his blood is compromised. This results in oxygen deprivation or hypoxia. Baby Ethan's body reacts to this by increasing his respiratory rate and nasal flaring to compensate with his hypoxia.
