Warm Chain in Newborn Baby

Warm chain
The "warm chain" is a set of ten interlinked procedures carried out at birth and during the following
hours and days which will minimize the likelihood of hypothermia in all newborns.
CONCEPT OF "WARM CHAIN
The concept of warm chain was introduced to describe a set of interlinked procedures to
minimize the likelihood of hypothermia in all neonates.
The links of warm chain are
 warmth at birth place
 warmth during transportation
 warmth at hospital or home.

10 point guideline for warm chain:-
 Warm delivery room. (25 to 28) 0c.

 Immediate drying with pre warmed towel-Drying and wrapping the baby immediately at
birth.
 Skin-to-skin contact between baby and the mother.
 Breast-feeding -Early initiation of breastfeeding within one hour of the birth; the warm
milk and contact with the mother's body helps to keep the newborn baby warm.
 Bathing and weighing postponed.
 Appropriate clothing/bedding.
 Mother and baby together.
 Warm transportation.
 Warm resuscitation - Keeping the baby warm during any procedure, including resuscitation. If
assessment or resuscitation is required, the infant should be placed under a radiant warmer
with skin temperature monitoring.
 Training and awareness raising of healthcare provider.
A. Warm delivery room (more than 25°C) which is free from draught.
 Warm reception and resuscitation of all neonates
 Immediate drying and wrapping
B. Skin to skin contact between the mother and neonate (kangaroo mother care)
 Putting in mother's breast within half an hour of birth
 Appropriate clothing, and bedding and covering head properly
 Mother and baby nursed together (bedding in or rooming-in) in the delivery room or in
lying in ward.
 Keep the baby in skin to skin contact with mother in kangaroo method at least for one hour to
maintain temperature, facilitate breastfeeding and improve mother-infant bonding.
C. Allowing breastfeeding with half an hour of birth or as early as possible to provide

warmth, nutrition and protection. Continuous observation of thermal state and other
vital
D. Baby bath should be postponed. Cleaning of blood and meconium should be done
with lukewarm water. Undue exposure of the baby should be avoided during nursing
procedures.
E. Baby should be transferred after establishment of thermal stability.
 Assess the baby's condition and temperature.
 Baby's hands and feet should be as warm as abdomen.
 Baby can be transferred in skin to skin contact with mother in kangaroo method or
mother can keep the baby close to her chest.
 Baby should be wrapped in prewarmed cloth.
 Baby's head, and extremities should be covered properly avoid undressing the
baby unnecessarily.
 Baby can be transferred within thermocol box with prewarmed linen, plastic
bubble sheet or silver swaddler.
 Simple open transport trolley should be avoided to transport the baby
Preventive measures to reduce heat losses from the baby should be followed.
 IV infusion with 10% dextrose, oxygen therapy and vitamin K injection (1 mg for
term baby and 0.5 mg for preterm baby) should be administered along with routine
and supportive care.
 Preventive measures should be implemented against neonatal hypothermia to reduce

morbidity and improved survival of newborn babies, which are easier than the
curative management and rewarming for neonatal hypothermia.
 Good quality obstetrical and neonatal care services and attention of concerned health
care providers are essential for prevention of this health hazards.
 The health worker and mother should have knowledge and skill for assessment and
prevention of hypothermia with use of common sense, which is more important than
the availability of expensive equipment to keep the baby warm.
REGULATING TEMPERATURE
All high-risk infants may have difficulty maintaining temperature because, in addition
to stress from an illness or immaturity, the infant's body is often exposed for long periods
during procedures such as resuscitation.
It's important to keep newborns in a neutral-temperature environment, one that is
neither too hot nor too cold because(PURPOSE)
 doing so places less demand on them to maintain a minimal metabolic rate necessary
for effective body functioning.
 If their environment becomes too hot, they are forced to decrease metabolism to cool
their body.
 If it becomes too cold, they must increase their metabolism to warm body cells.
Increased metabolism can be destructive because it calls for increased oxygen, and
 without this oxygen available because of respiratory difficulty, body cells become
hypoxic.
 To spare oxygen for essential body functions, vasoconstriction of peripheralblood
vessels occurs so blood can be pushed into the central torso.
 If this process continues for too long a time, pulmonary vessels constrict and
pulmonary perfusion decreases. The infant's PO 2 level will fall and PCO2 will
increase. As mentioned previously, a lowered PO 2 level causes fetal shunts such as the
ductus arteriosus to remain open.
 Surfactant production in the lungs can halt as well, further interfering with lung
function.
 To supply glucose to maintain increased metabolism, an infant has to resort to
anaerobic glycolysis, which pours acid into the bloodstream.
 As the infant becomes more and more acidotic, the risk of acute bilirubin
encephalopathy or kernicterus (the accumulation of unconjugated bilirubin into brain
cells) increases as more bilirubin-binding sites are lost and more bilirubin is free to
pass out of the bloodstream in brain cells.
 In short, because of becoming chilled, heart action, breathing, electrolytic balance,
and possibly brain function all become compromised.
PROCESS OF WARM CHAIN
 In addition to covering the newborn with an infant cap, wiping the body and head dry
with a towel or blanket, and using a radiant warmer or prewarmed incubator suggest
skin-to-skin contact with one of the parents.
 Additional measures that can be used to ensure the infant's temperature stays between
36.5°C and 37.5°C (97.8°F and 99.5°F) axillary are plastic wrap, increasing the room
temperature, and warmed mattresses
 To prevent heat loss, be certain during any procedure that the infant is not placed on a
cool X-ray table or scale.
 Radiant Heat Sources
Radiant heat warmers are open beds that have an attached overhead source of radiant heat
and provide both warmth and visibility for observation. Such units have small probes,
covered by a small shield, often silver metallic, which when placed on the baby's skin,
register the baby's temperature. Abdominal skin temperature, when measured this way, should
be 95.9° to 97.7°F (35.5° to 36.5°C). If an infant's temperature falls below this level, an alarm
on the unit can be set to sound. Be certain, with the infant laying on his or her back, you tape
the probe or disk onto the infant's abdomen between the umbilicus and the xiphoid process.
An additional warming pad placed under an infant may be necessary for very preterm infants
or for lengthy procedures to maintain body heat.
 Incubators
Newborns needing both warmth and visual observation may also be cared for in incubators.
By placing the baby in such a steady, warm environment, the need for clothing can be
eliminated, so the observation for any respiratory difficulty, possible color changes, or
unusual movements (such as seizures) can be readily observed. The temperature of incubators
varies with the amount of time portholes remain open and the temperature of the area in
which the incubator is placed. Placing one in direct sunlight or near a warm radiator, for
example, can increase the internal temperature markedly. Placing it near a cold window can
decrease the temperature helps prevent radiation and convection heat loss when portholes are
opened and may be necessary for very immature infants.
 Similar to radiant warmers, some incubators have servo control mechanism units that
monitor the infant's temperature once the probe is placed on their abdomen and
automatically changes the temperature of the incubator as needed. Portholes must
remain closed to keep the servo control operating efficiently.
As infants become both medically stable and old enough to maintain a steady body
temperature, they can be weaned from an incubator. Dress the infant as if he or she were
going to be in a bassinet and then set the incubator about 2°F (1.2°C) below the infant's
temperature. After a half hour, assess whether the infant is able to maintain body temperature.
If so, lower the incubator temperature another 2°F and continue until room temperature is
reached.
 Skin-to-Skin Care
Originally referred to as kangaroo care, skin-to-skin care is the use of skin-to-skin contact
with a parent to maintain body heat. Provide a quiet setting with lights dimmed. Undress the
infant except for a diaper and a cap. Assist the parent to sit comfortably in a chair and hold
the infant snugly against his or her unclothed chest, skin to skin. Place a blanket over the
infant for added warmth. This method of care not only supplies heat but also encourages
parent-child bonding.

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Warm chain

CONCEPT OF "WARM CHAIN

The links of warm chain are

 warmth at birth place

 warmth during transportation

 warmth at hospital or home.

 Warm delivery room. (25 to 28) 0c.

 Putting in mother's breast within half an hour of birth

 Appropriate clothing, and bedding and covering head properly

C. Allowing breastfeeding with half an hour of birth or as early as possible to provide

E. Baby should be transferred after establishment of thermal stability.

 Assess the baby's condition and temperature.

 Baby's hands and feet should be as warm as abdomen.

 Baby should be wrapped in prewarmed cloth.

 Preventive measures should be implemented against neonatal hypothermia to reduce

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