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Improving admission temperature in extremely low birth weight infants: a hospital-based multi-intervention quality improvement project

  • Zeenia Billimoria , Sanjay Chawla EMAIL logo , Monika Bajaj and Girija Natarajan
Published/Copyright: January 19, 2013
Journal of Perinatal Medicine
From the journal Journal of Perinatal Medicine Volume 41 Issue 4

Abstract

Objective: To reduce the incidence of hypothermia (admission temperatures <36°C) in extremely low birth weight (ELBW) neonates using a multi-intervention quality improvement (QI) initiative.

Study design: We conducted a multi-intervention QI initiative to reduce hypothermia (admission temperatures <36°C) among preterm ELBW (≤1000 g birth weight) neonates born at Hutzel Women’s Hospital. The QI project was conducted in three periods: period 1, traditional thermal care of drying and wrapping in towel; period 2, wrapping in plastic wrap without first drying; and period 3, periodic staff education, additional use of chemical warming mattress, and increase in operating room temperature from 20°C to 21°C. Statistical analysis included ANOVA, χ2, and logistic regression as appropriate.

Results: In our cohort of 209 patients, baseline characteristics were comparable in the three periods except for a reduction in the need for surfactant doses in the 3rd period. Temperature on admission to the neonatal intensive care unit was significantly higher, with a reduction in hypothermia in the 3rd period. There was no patient with a temperature of ≥37.5°C. On logistic regression, with gestational age, 5-min Apgar score, and mode of delivery as covariates, time period 3 was significantly associated with a reduction in the incidence of hypothermia (P=0.02).

Conclusion: A concerted QI approach improved admission temperature in ELBW neonates, with more neonates in the euthermic range, without increasing the risk for hyperthermia. Such an approach could be associated with improved outcomes in this population.

Keywords: Hypothermia; preterm; quality improvement
Corresponding author: Sanjay Chawla, MD, Assistant Professor, Division of Neonatology, Children’s Hospital of Michigan and Hutzel Women’s Hospital, Wayne State University 4th Floor, 3901 Beaubien Street, Detroit, MI 48201, USA, Tel.: +313 745 5638, Fax: +313 745 5867

References

[1] American Academy Pediatrics. Neonatal Resuscitation: 2010 American Heart Association Guidelines for Cardiopulmonary Resuscitation and Emergency Cardiovascular Care. Pediatrics. 2010;126:1400–13.10.1542/peds.2010-2972ESearch in Google Scholar

[2] Bailey J, Rose P. Temperature measurement in the preterm infant: a literature review. J Neonatal Nurs. 2000;6:28–32.Search in Google Scholar

[3] Bissinger RL, Annibale DJ. Thermoregulation in very low birth weight infants during the golden hour: results and implications. Adv Neonatal Care. 2010;10:230–8.10.1097/ANC.0b013e3181f0ae63Search in Google Scholar

[4] Chadd MA, Gray OP. Hypothermia and coagulation defects in the newborn. Arch Dis Child. 1972;47:819–21.10.1136/adc.47.255.819Search in Google Scholar

[5] Chawla S, Amaram A, Gopal SP, Natarajan G. Safety and efficacy of trans-warmer mattress for preterm neonates: results of a randomized controlled trial. J Perinatol. 2011;31:780–4.10.1038/jp.2011.33Search in Google Scholar

[6] Fanaroff AA, Stoll BJ, Wright LL, Carlo WA, Ehrenkranz RA, Stark AR, et al. Trends in neonatal morbidity and mortality for very low birthweight infants. Am J Obstet Gynecol. 2007;196:147.e1–8.10.1016/j.ajog.2006.09.014Search in Google Scholar

[7] Goldenberg RL, Culhane JF, Iams JD, Romero R. Epidemiology and causes of preterm birth. Lancet. 2008;371:75–84.10.1016/S0140-6736(08)60074-4Search in Google Scholar

[8] Hamilton BE, Martin JA, Ventura SJ. Births: preliminary data for 2010. Natl Vital Stat Rep. 2011;60:1–26.Search in Google Scholar

[9] Harms K, Herting E, Kron M, Schill N, Schiffmann H. Importance of pre- and perinatal risk factors in respiratory distress syndrome of premature infants. A logical regression analysis of 1100 cases. Z Geburtshilfe Neonatol. 1997;201:258–62.Search in Google Scholar

[10] Ibrahim CP, Yoxall CW. Use of plastic bags to prevent hypothermia at birth in preterm infants – do they work at lower gestations? Acta Paediatr. 2009;98:256–60.10.1111/j.1651-2227.2008.01076.xSearch in Google Scholar PubMed

[11] Ibrahim CP, Yoxall CW. Use of self-heating gel mattresses eliminates admission hypothermia in infants born below 28 weeks gestation. Eur J Pediatr. 2010;169:795–99.10.1007/s00431-009-1113-ySearch in Google Scholar PubMed

[12] Kent AL, Williams J. Increasing ambient operating theatre temperature and wrapping in polyethylene improves admission temperature in premature infants. J Paediatr Child Health. 2008;44:325–31.10.1111/j.1440-1754.2007.01264.xSearch in Google Scholar PubMed

[13] Knobel RB, Wimmer JE Jr, Holbert D. Heat loss prevention for preterm infants in the delivery room. J Perinatol. 2005;25:304–8.10.1038/sj.jp.7211289Search in Google Scholar PubMed

[14] Laptook AR, Watkinson M. Temperature management in the delivery room. Semin Fetal Neonatal Med. 2008;13:383–91.10.1016/j.siny.2008.04.003Search in Google Scholar

[15] Laptook AR, Salhab W, Bhaskar B. Admission temperature of low birth weight infants: predictors and associated morbidities. Pediatrics. 2007;119:e643–9.10.1542/peds.2006-0943Search in Google Scholar

[16] Lee H, Ho Q, Rhine W. A quality improvement project to improve admission temperatures in very low birth weight infants. J Perinatol. 2008;28:754–8.10.1038/jp.2008.92Search in Google Scholar

[17] Mance MJ. Keeping infants warm. Adv Neonatal Care. 2008;8:6–12.10.1097/01.ANC.0000311011.33461.a5Search in Google Scholar

[18] Miller S, Lee H, Gould J. Hypothermia in very low birth weight infants: distribution, risk factors and outcomes. J Perinatol. 2011;31:49–56.10.1038/jp.2010.177Search in Google Scholar

[19] Papile LA, Burstein J, Burstein R, Koffler H. Incidence and evolution of subependymal and intraventricular hemorrhage: a study of infants with birth weights less than 1,500 gm. J Pediatr. 1978;92:529–34.10.1016/S0022-3476(78)80282-0Search in Google Scholar

[20] Schriefer J, Leonard MS. Patient safety and quality improvement: an overview of QI. Pediatr Rev. 2012;33:353–9; quiz 359–60.10.1542/pir.33.8.353Search in Google Scholar

[21] Singh A, Duckett J, Newton T, Watkinson M. Improving neonatal unit admission temperatures in preterm babies: exothermic mattresses, polythene bags or a traditional approach? J Perinatol. 2010;30:45–9.10.1038/jp.2009.94Search in Google Scholar PubMed

[22] Vohra S, Roberts RS, Zhang B, Janes M, Schmidt B. Heat loss prevention (HeLP) in the delivery room: a randomized controlled trial of polyethylene occlusive skin wrapping in very preterm infants. J Pediatr. 2004;145:750–3.10.1016/j.jpeds.2004.07.036Search in Google Scholar PubMed

The authors stated that there are no conflicts of interest regarding the publication of this article.

Received: 2012-10-30
Accepted: 2012-12-20
Published Online: 2013-01-19
Published in Print: 2013-07-01

©2013 by Walter de Gruyter Berlin Boston

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https://doi.org/10.1515/jpm-2012-0259
Keywords for this article
Hypothermia; preterm; quality improvement

Articles in the same Issue

  1. Masthead
  2. Masthead
  3. Review article
  4. Anxious and depressive components of Edinburgh Postnatal Depression Scale in maternal postpartum psychological problems1)
  5. Original Articles – Obstetrics
  6. Isolated low-normal amniotic fluid volume in the early third trimester: association with adverse perinatal outcomesa
  7. Trends in twin pregnancies and mode of delivery during the last 30 years: inconsistency between guidelines and clinical practice
  8. Prenatal care in adult women exposed to childhood sexual abuse
  9. Maternal and fetal adropin levels in gestational diabetes mellitus
  10. Ethnic disparities in perinatal mortality at 40 and 41 weeks of gestation
  11. Polymorphisms in the activin A receptor type 2A gene affect the onset time and severity of preeclampsia in the Turkish population
  12. Outcome of isolated fetal renal pyelectasis diagnosed during midtrimester screening ultrasound and cut-off value to predict a persistent or progressive pyelectasis in utero
  13. A polymorphism in an autophagy-related gene, ATG16L1, influences time to delivery in women with an unfavorable cervix who require labor induction
  14. Management of gestational hypertension – the impact of HYPITATa
  15. Reliability of quantitative elastography of the uterine cervix in at-term pregnancies
  16. Congenital anomalies, prematurity, and low birth weight rates in relation to nuclear power plant proximity1)
  17. Original Articles – Fetus
  18. Fetal magnetic resonance imaging of lymphangiomas
  19. Original Articles – Newborn
  20. Brainstem dysgenesis during the neonatal period: diagnosis and management
  21. Improving admission temperature in extremely low birth weight infants: a hospital-based multi-intervention quality improvement project
  22. Short Communication
  23. Periconceptional use of folic acid and risk of miscarriage – findings of the Oral Cleft Prevention Program in Brazil
  24. Congress Calendar
  25. Congress Calendar
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