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Summary
In the second part of this two part article the neonatal energy triangle elements of hypoxia and hypothermia are explored and the physiology of the first few hours of neonatal life drawn together into an integrated whole. This framework can assist in understanding the three most common difficulties encountered by the preterm baby and directing integrated and holistic care.
Keywords
Neonates, Thermoregulation, Metabolism, Physiology
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Aim and intended learning outcomes
The second part of this two part article continues discussion of the Neonatal Energy Triangle (see Figure 1) a conceptual framework which is intended to support the early care of the preterm baby on admission to the neonatal unit. Hypoglycaemia was addressed in the July issue as the first of the three most common difficulties encountered by the preterm baby in this period. The accumulating impact and consequences of hypothermia and hypoxia are considered here and the three Hs drawn together into an integrated model. After reading these two articles and undertaking the exercises within them you should be able to:
* Describe mechanisms of glucose homeostasis, respiratory adaptation and thermostasis in the preterm baby
* Summarise how the mechanisms above inter-relate with each other
* Analyse the main aims of assessment in the neonatal transition period
* Identify and prioritise care delivery within the first six to 12 hours of admission
* With reference to hypothermia, hypoglycaemia and hypoxia explain the importance of a holistic and integrated care approach in the arrangement of care.
Thermoregulatory adaptation
Fetal mechanisms for the cold stress response are not active in-utero as the mother constitutes a massive heat reservoir. The baby's core temperature is generally 0.5°C above the mother's core temperature and his/her peripheral and core temperatures are almost exactly the same (Rutter and Hull 1979). The fetus, therefore, does not thermoregulate.
The infant is characteristically born into a wet, cold and hostile environment. Rapid evironmental cooling occurs with body temperatures dropping at a rate of 0.2-1.0°C/min depending on gestational age and the environmental factors encountered (Rutter...