PE24.17-20 | Emergency Thermal Care — Summary & Reflection

KEY TAKEAWAYS

Emergency thermal care encompasses both hypothermia and hyperthermia management:
• Hypothermia (axillary <36.5°C): mild 36.0–36.4°C, moderate 32–35.9°C, severe <32°C
• Clinical features: cold skin, lethargy, poor feeding, peripheral cyanosis, bradycardia in severe cases
• Always check BGL in a hypothermic neonate — hypoglycaemia co-exists and must be treated
• WHO warm chain (10 steps): warm room, dry immediately, skin-to-skin, breastfeed, delay bath, keep together, warm transport, warm resuscitation, warm procedures, training
• KMC technique: infant prone/upright on mother's bare chest, head in sniffing position, hat + nappy, maternal clothing wrapped around; advantages: zero cost, promotes breastfeeding, reduces infection
• Rewarming rate: no faster than 1°C/hour; temperature every 15–30 min; target ≥36.5°C × 2 readings
• Hyperthermia/heat stroke: core >40°C + CNS signs = emergency; tepid sponging + fanning; antipyretics ineffective; target <38.5°C; no whole-body ice packs
• Environmental measures: room ≥25°C, no draughts, clothing + hat, warm surfaces, delay bath ≥24 hours

REFLECT

Consider the warm chain as a system — it works only if every step is maintained by every person who touches the baby. A nurse who warms the delivery room but forgets to close the window before the procedure undermines the whole chain. A doctor who correctly positions KMC but then removes the baby for a 15-minute examination in a cool procedure room breaks it. Temperature protection is collective and continuous, not an individual act. In your future clinical practice — whether as a general practitioner, paediatrician, or obstetrician — you will be responsible for your section of that chain. What specific part of the warm chain do you think is most commonly violated in the health facility you have trained in, and what would it take to change that?