Perinatal quality improvement bundle to decrease hypothermia in extremely low birthweight infants with birth weight...

Area of Science:

• Neonatalogy
• Perinatal Medicine
• Pediatric Critical Care

Background:

• Normothermia (36.5°C-37.5°C) on admission to the neonatal intensive care unit (NICU) is linked to better outcomes for extremely low birthweight (ELBW) infants (<1000 g).
• Hypothermia (<36.5°C) in ELBW infants is associated with increased morbidity, mortality, longer hospital stays, and higher costs.

Purpose of the Study:

• To implement and evaluate a thermoregulation bundle aimed at decreasing hypothermia in ELBW infants.
• To improve the rate of normothermia upon NICU admission for ELBW infants.

Main Methods:

• A multidisciplinary quality improvement initiative was undertaken.
• Key interventions included a dedicated delivery/operating room (DR/OR) maintained at 74°F, exothermic mattress, preheated radiant warmer, servo-controlled mode, plastic wrap, head cap, and warm towels.
• Data were collected for 200 ELBW infants admitted between January 2014 and December 2019.

Main Results:

• Hypothermia occurred in 2.5% of ELBW infants, while 91% achieved normothermia.
• Transitional hyperthermia (>37.5°C) was observed in 6.5% of infants.
• No cases of moderate hypothermia (32°C-36°C) were recorded over the 6-year study period.

Conclusions:

• The implemented thermoregulation bundle was effective in significantly reducing hypothermia rates in ELBW infants.
• Achieving and maintaining normothermia in ELBW infants requires sustained, collaborative quality improvement efforts.
• Eliminating hypothermia remains an ongoing challenge in the care of ELBW infants.