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13 October, 2021

Fever In Newborn

Normal body temperature is 98.6 F or 37 C (+/- 0.5 C).

Any body temperature greater than 99.5 F or 37. 5 C is termed as fever in newborns.

Fever is the body’s defense mechanism that helps to fight infection or inflammation.

How to measure fever: By using a digital thermometer in the axilla (armpit) or with the help of an infrared thermometer which measures the skin temperature (usually measured from the forehead)

Causes of fever: 

  • Dehydration (due to poor feeding)
  • Hot environment or proximity to sunlight
  • Wrapping the baby in too many clothes
  • Infection
  • Postvaccination
  • Maternal fever at the time of delivery

Symptoms: The baby may be irritable, appear flushed, have either fast breathing or decreased breathing efforts, have dull activity, abnormal tone, and decreased intake of feeds

Untreated fever or infection may lead to seizures and has increased risk of mortality. 

What to do when your baby has fever:

First unwrap the baby and keep the baby in a normal environment (25-28 C). Try to give breastfeed/expressed breast milk as spoon feed to the baby. Recheck the temperature after 20-30 minutes. 

If baby’s temperature is normal and baby is feeding adequately, ensure frequent feeds. A properly fed baby sleeps comfortably between two feeding sessions, passes urine 8-10 times in a day and gains weight consistently.

If the baby is still having a temperature of > 99.5 F, or having any other symptoms mentioned above, approach the doctor as early as possible for complete evaluation of dehydration/ infection. 

KEEPING BABIES WARM (PREVENTING HYPOTHERMIA)

Normal body temperature in adults is maintained by metabolism (through brown fat stored inside the body) as well as by shivering.

Babies, before they were born, lie inside the mother’s womb, where the amniotic fluid keeps the baby warm.

Normal body temperature of newborns measured in the axilla(armpit) is between 36.5 C- 37.5 C.

After birth babies tend to become hypothermic due to the cold environment and also because of not able to generate appropriate shivering response.

Low body temperature leads to dull activity, poor feeding, increased risk of infections and also increased risk of mortality.

How to avoid hypothermia (or low body temperature) in term babies:

  • Immediately after birth baby should be dried fully with a clean towel and placed on the mother’s chest/ abdomen.
  • Breast feeding should be initiated within 1 hour of birth and baby should be roomed in with the mother throughout the day.
  • Breast feeding should be encouraged every 2nd hourly, in the first few postnatal days.
  • Avoid bathing the baby until the cord falls off.
  • Keep the baby always covered with cap, socks, mittens and dress.
  • Keep the baby wrapped properly all the time.
  • Maintain the room temperature between 25- 28 C.
  • Avoid placing the baby near open window or doors where there might be exposure to cold air/draught.
  • The palms and soles of the baby should be as warm as the chest when the skin temperature of the baby is felt by the back of the parent’s hand. 
  • If the soles of the baby feel cold compared to chest, baby is in cold stress and needs to be clothed and wrapped properly
  • If for any reason, baby’s skin feels cold, or baby is dull with decreased intake of feeds, contact the health care personnel.

PREMATURE INFANTS:

Premature infants are more vulnerable to low body temperature because of:

  1. A higher skin surface area compared to weight.
  2. Thin skin with no subcutaneous fat which leads to evaporative heat loss.
  3. Less brown fat and poor vasomotor control.
  4. Inability to establish full feeds at birth due to gut immaturity

Therefore premature babies need to be cared for in the Neonatal Intensive Care Unit (NICU), where the babies will be placed under radiant warmers to maintain body temperature.

Very premature babies are usually placed inside incubators where the humidity of the baby’s environment can also be controlled to prevent evaporative heat losses through the skin.

Premature babies, if they need respiratory support are provided with heated and humidified air through bubble CPAPs or ventilators. 

Kangaroo mother care, initiated as soon as the baby is stable also keeps the baby warm.

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