history of thermoregulation §incubation traced as far back as the egyptians §napoleon brought back...
TRANSCRIPT
![Page 1: History of Thermoregulation §Incubation traced as far back as the Egyptians §Napoleon brought back to Parisian zoos §1800’s used for premature infants](https://reader036.vdocuments.site/reader036/viewer/2022070411/56649f4f5503460f94c71a32/html5/thumbnails/1.jpg)
History of Thermoregulation
Incubation traced as far back as the Egyptians
Napoleon brought back to Parisian zoos1800’s used for premature infants1907 started use of temperature control
![Page 2: History of Thermoregulation §Incubation traced as far back as the Egyptians §Napoleon brought back to Parisian zoos §1800’s used for premature infants](https://reader036.vdocuments.site/reader036/viewer/2022070411/56649f4f5503460f94c71a32/html5/thumbnails/2.jpg)
![Page 3: History of Thermoregulation §Incubation traced as far back as the Egyptians §Napoleon brought back to Parisian zoos §1800’s used for premature infants](https://reader036.vdocuments.site/reader036/viewer/2022070411/56649f4f5503460f94c71a32/html5/thumbnails/3.jpg)
![Page 4: History of Thermoregulation §Incubation traced as far back as the Egyptians §Napoleon brought back to Parisian zoos §1800’s used for premature infants](https://reader036.vdocuments.site/reader036/viewer/2022070411/56649f4f5503460f94c71a32/html5/thumbnails/4.jpg)
![Page 5: History of Thermoregulation §Incubation traced as far back as the Egyptians §Napoleon brought back to Parisian zoos §1800’s used for premature infants](https://reader036.vdocuments.site/reader036/viewer/2022070411/56649f4f5503460f94c71a32/html5/thumbnails/5.jpg)
![Page 6: History of Thermoregulation §Incubation traced as far back as the Egyptians §Napoleon brought back to Parisian zoos §1800’s used for premature infants](https://reader036.vdocuments.site/reader036/viewer/2022070411/56649f4f5503460f94c71a32/html5/thumbnails/6.jpg)
Basal Metabolic Rate
Human body produces heat as by-product of metabolism
![Page 7: History of Thermoregulation §Incubation traced as far back as the Egyptians §Napoleon brought back to Parisian zoos §1800’s used for premature infants](https://reader036.vdocuments.site/reader036/viewer/2022070411/56649f4f5503460f94c71a32/html5/thumbnails/7.jpg)
Neutral Thermal Environment
Narrow range of environmental temperatureInfant is not required to adjust heat
production above natural resting levelsMinimal oxygen consumptionUltimate goal
![Page 8: History of Thermoregulation §Incubation traced as far back as the Egyptians §Napoleon brought back to Parisian zoos §1800’s used for premature infants](https://reader036.vdocuments.site/reader036/viewer/2022070411/56649f4f5503460f94c71a32/html5/thumbnails/8.jpg)
Shivering and Sweating
Adults - Shivering is heat production from voluntary and involuntary rhythmic muscle activity. Sweating decreases heat by vasodilation and evaporation.
Neonates - Unable to produce heat by shivering. Infants < 30 weeks cannot sweat, and have 1/3 the response > 32 weeks.
![Page 9: History of Thermoregulation §Incubation traced as far back as the Egyptians §Napoleon brought back to Parisian zoos §1800’s used for premature infants](https://reader036.vdocuments.site/reader036/viewer/2022070411/56649f4f5503460f94c71a32/html5/thumbnails/9.jpg)
Non-shivering Thermogenesis Brown Fat Metabolism
Brown Fat is Found:
Around the great vessels
Adrenal glandsKidneys
Axillas Nape of neck Between the scapulas
![Page 10: History of Thermoregulation §Incubation traced as far back as the Egyptians §Napoleon brought back to Parisian zoos §1800’s used for premature infants](https://reader036.vdocuments.site/reader036/viewer/2022070411/56649f4f5503460f94c71a32/html5/thumbnails/10.jpg)
Brown Fat Metabolism
Most important means of heat production in neonates
Present at 26 - 28 weeks gestation & increases until 3 - 5 weeks postnatal
Comprises 2.7% of total body weight in term infant
Cannot be replenished
![Page 11: History of Thermoregulation §Incubation traced as far back as the Egyptians §Napoleon brought back to Parisian zoos §1800’s used for premature infants](https://reader036.vdocuments.site/reader036/viewer/2022070411/56649f4f5503460f94c71a32/html5/thumbnails/11.jpg)
Heat Transfer
ConductionRadiationConvectionEvaporation
![Page 12: History of Thermoregulation §Incubation traced as far back as the Egyptians §Napoleon brought back to Parisian zoos §1800’s used for premature infants](https://reader036.vdocuments.site/reader036/viewer/2022070411/56649f4f5503460f94c71a32/html5/thumbnails/12.jpg)
Conduction
Transfer of heat between solid objects in direct contact
Cold scale, circumcision board, mattress
Chemically activated warmers, heated water mattresses, skin-to-skin
> on metals, < on cloth
![Page 13: History of Thermoregulation §Incubation traced as far back as the Egyptians §Napoleon brought back to Parisian zoos §1800’s used for premature infants](https://reader036.vdocuments.site/reader036/viewer/2022070411/56649f4f5503460f94c71a32/html5/thumbnails/13.jpg)
Convection
Transfer of heat to the air moving across and around the body
Varies based on temperature gradient, body surface exposed and speed of air movement
![Page 14: History of Thermoregulation §Incubation traced as far back as the Egyptians §Napoleon brought back to Parisian zoos §1800’s used for premature infants](https://reader036.vdocuments.site/reader036/viewer/2022070411/56649f4f5503460f94c71a32/html5/thumbnails/14.jpg)
EvaporationHeat loss by conversion of
liquid into vaporMainly transepidermal
water loss (insensible) As relative humidity
the water loss with tachypnea,
activity, radiant warmers and phototherapy
as skin thickens and is less permeable
![Page 15: History of Thermoregulation §Incubation traced as far back as the Egyptians §Napoleon brought back to Parisian zoos §1800’s used for premature infants](https://reader036.vdocuments.site/reader036/viewer/2022070411/56649f4f5503460f94c71a32/html5/thumbnails/15.jpg)
RadiationTransfer of heat
between solid objects that are not in direct contact
Surrounding walls and windows, including isolette walls
Accounts for 64% of the total dry heat loss in premature infants
![Page 16: History of Thermoregulation §Incubation traced as far back as the Egyptians §Napoleon brought back to Parisian zoos §1800’s used for premature infants](https://reader036.vdocuments.site/reader036/viewer/2022070411/56649f4f5503460f94c71a32/html5/thumbnails/16.jpg)
Hypothermia
Short-term : Hypoglycemia, hypoxia, metabolic acidosis (metabolism of brown fat), anaerobic metabolism
Long-term : Impaired weight gain, RDS, heart failure, depletion of energy sources
At risk : Premature infants, small for gestational age, infants stressed due to sepsis, RDS, asphyxia
![Page 17: History of Thermoregulation §Incubation traced as far back as the Egyptians §Napoleon brought back to Parisian zoos §1800’s used for premature infants](https://reader036.vdocuments.site/reader036/viewer/2022070411/56649f4f5503460f94c71a32/html5/thumbnails/17.jpg)
Hyperthermia
Causes : Overheating, phototherapy, sepsis, CNS disorders, dehydration, maternal fever
![Page 18: History of Thermoregulation §Incubation traced as far back as the Egyptians §Napoleon brought back to Parisian zoos §1800’s used for premature infants](https://reader036.vdocuments.site/reader036/viewer/2022070411/56649f4f5503460f94c71a32/html5/thumbnails/18.jpg)
RCNIC Guidelines
Core temperature 36.2 - 37.5°CAxillary temperature 36.2 - 37.5°CAbdominal skin temp 36.0 - 36.5°C
Temperature probes on abdomen or flanksUse hats & socks
![Page 19: History of Thermoregulation §Incubation traced as far back as the Egyptians §Napoleon brought back to Parisian zoos §1800’s used for premature infants](https://reader036.vdocuments.site/reader036/viewer/2022070411/56649f4f5503460f94c71a32/html5/thumbnails/19.jpg)
Radiant Warmer
Reflective covers on temperature probesWarm in non-servo (air-control) at
maximum heat before admissionServo control (patient control) with skin
temp set at 36.5 °C
![Page 20: History of Thermoregulation §Incubation traced as far back as the Egyptians §Napoleon brought back to Parisian zoos §1800’s used for premature infants](https://reader036.vdocuments.site/reader036/viewer/2022070411/56649f4f5503460f94c71a32/html5/thumbnails/20.jpg)
Isolettes
Servo control for < 1250 gramsNon-servo control >1250 gramsAvoid obstructing airflow
![Page 21: History of Thermoregulation §Incubation traced as far back as the Egyptians §Napoleon brought back to Parisian zoos §1800’s used for premature infants](https://reader036.vdocuments.site/reader036/viewer/2022070411/56649f4f5503460f94c71a32/html5/thumbnails/21.jpg)
![Page 22: History of Thermoregulation §Incubation traced as far back as the Egyptians §Napoleon brought back to Parisian zoos §1800’s used for premature infants](https://reader036.vdocuments.site/reader036/viewer/2022070411/56649f4f5503460f94c71a32/html5/thumbnails/22.jpg)
True Story
When the transport team in Denver started fixed wing air transport, they had difficulty keeping infants warm.
First trip: Full-term, preheated 37 °C incubator.
![Page 23: History of Thermoregulation §Incubation traced as far back as the Egyptians §Napoleon brought back to Parisian zoos §1800’s used for premature infants](https://reader036.vdocuments.site/reader036/viewer/2022070411/56649f4f5503460f94c71a32/html5/thumbnails/23.jpg)
Second Transport
Added 50 % humidity Increased incubator to 38 °CMinimized time portholes were openPreheated diapers and blankets
![Page 24: History of Thermoregulation §Incubation traced as far back as the Egyptians §Napoleon brought back to Parisian zoos §1800’s used for premature infants](https://reader036.vdocuments.site/reader036/viewer/2022070411/56649f4f5503460f94c71a32/html5/thumbnails/24.jpg)
Third Transport
Heated airplane cabin to 35 °C (95 °F)
![Page 25: History of Thermoregulation §Incubation traced as far back as the Egyptians §Napoleon brought back to Parisian zoos §1800’s used for premature infants](https://reader036.vdocuments.site/reader036/viewer/2022070411/56649f4f5503460f94c71a32/html5/thumbnails/25.jpg)
![Page 26: History of Thermoregulation §Incubation traced as far back as the Egyptians §Napoleon brought back to Parisian zoos §1800’s used for premature infants](https://reader036.vdocuments.site/reader036/viewer/2022070411/56649f4f5503460f94c71a32/html5/thumbnails/26.jpg)