Cold Stress & Sugar w/ Theresa Bowden
Let’s talk about something that I am passionate about: babies. I’ll talk about anything concerning newborns, big or small. Sick or not sick- but given my work over the last years, I particularly encounter babies that are sick. The problem with babies (and kids, for that matter), is they look good, until they don’t. So, it’s up to us as healthcare providers, to try to stay ahead of the situation. There are so many facets to newborns- even though it happens all the time, it’s always amazing to see the ones who don’t need our interventions to survive- pretty cool.
Take hypothermia, for instance. I just completed my first on-line module in the FOAMfrat Library on Neonatal Resuscitation. Happy to report, I did fine: but the anxiety was a bit high, since babies are my favorite. I loved the experiment related to keeping babies warm in the back of an ambulance. You can check out the experiment by clicking on the video below.
This legit a very difficult task to master. Even in hospital settings, keeping a baby warm can get overlooked when the team is focused on resuscitation. The thing about hypothermia is: hypothermia has a friend- that friend is hypoglycemia.
These two friends are not allowed to “hang-out” together because they make poor choices. Meaning: if one goes south, the other will follow. Therefore: if you have a newborn who you are struggling to keep warm (I aim for 37⁰C Axillary), you should check a blood glucose. And if you have a baby who you have noted to have a low blood glucose (generally <40 mg/dL), you should check their temperature. And correcting one, before the other notices- will save you from the spiral of doom that it sure to happen.
A newborn’s temperature can drop as quickly as 0.2-1⁰C per minute- and hypothermia is preventable. Babies will respond by peripheral vasoconstriction (arms and legs), increased muscle flexion and activity (to decrease their surface area and generate heat by moving), and the ones who have it- will metabolize their brown fat (this increases heat production). An important fact here is for these responses to be effective, the metabolic rate MUST increase, which increases their use of oxygen and glucose. Well, there ya go…….
Now we gotta involve the hypothalamus that is releasing norepinephrine in response to the cold stress. The norepinephrine does just what we know it will: it causes peripheral vasoconstriction, increased metabolic rate -> increased oxygen and glucose consumption. And recall what happens with prolonged peripheral vasoconstriction…. Tissue perfusion/oxygenation are impaired ->anaerobic metabolism -> lactic acid increases & pH decreases -> acidosis…. And now we have PULMONARY vasoconstriction!!! This right-to-left shunting just adds to our hypoxemic state….. and we might as well throw in impaired coagulation and impaired surfactant production to the situation.
So……. I love it in medicine when we can prevent something from happening. Avoiding heat loss with newborns is something we can prevent. Utilize your resources such as: hats/blankets, increasing the heat in the ambulance, Portawarmers, and if the infant is premature- you can place them in the bag your ambu came in (up to their shoulders) if you don’t have a fancy NeoWrap. Like the Foam Frat module explained: if the baby looks good- put skin-to-skin with the mom. Bonus points if the baby will nurse a bit, as this colostrum is jam-packed with nutrients which will keep the blood glucose up AND the oxytocin that is released when breastfeeding will help the uterus contract- helping with postpartum bleeding. WIN-WIN-WIN.
Theresa Bowden is a flight nurse in Washington and the Assistant Teaching Professor at Washington State University College of Nursing. She specializes in NICU & Pediatric transport and we are happy to have her sharing her knowledge with us in a guest blog for FOAMfrat. You can follow Theresa on Twitter @Bowden4Theresa.