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Esophageal Heat Transfer for Patient Temperature Control and Targeted Temperature Management
Published on: November 21, 2017
Implementation of a temperature bundle improves admission hypothermia in very-low-birth-weight infants in China: a
Li Wang1,2, Zhi-Jie Liu3, Feng-Min Liu4
1Neonatology, Shandong Provincial Hospital Affiliated to Shandong First Medical University, Jinan, Shandong, China.
Insights
A quality improvement project significantly reduced hypothermia in very-low-birth-weight (VLBW) infants in China. Interventions improved infant temperature and lowered mortality rates in neonatal intensive care units (NICUs).
Area of Science:
- Neonatal Medicine
- Quality Improvement Science
- Pediatric Critical Care
Background:
- Hypothermia is a significant risk factor for mortality and morbidity in preterm infants, particularly in China.
- Very-low-birth-weight (VLBW) infants are especially vulnerable to hypothermia upon admission to neonatal intensive care units (NICUs).
- Previous studies indicated a high incidence of admission hypothermia among VLBW infants in the region.
Purpose of the Study:
- To evaluate the effectiveness of a targeted quality improvement (QI) initiative aimed at preventing hypothermia in VLBW infants.
- To assess the impact of specific hypothermia prevention measures on infant outcomes in Chinese NICUs.
- To compare hypothermia incidence and associated mortality before and after QI implementation.
Main Methods:
- A prospective study comparing pre-QI (2018) and post-QI (2019) periods in three tertiary NICUs.
- Enrollment of preterm infants (<32 weeks gestation, VLBW <1500g).
- Implementation of a 'temperature bundle' including transport incubators, prewarmed hats, polyethylene wrap, staff training, and standardized documentation.
Main Results:
- The incidence of hypothermia decreased significantly from 92.3% to 62% (p<0.001) after QI implementation.
- Mean admission body temperature increased from 35.5°C to 36°C (p<0.001).
- Infant mortality rate was significantly lower in the post-QI group (8.8% vs 16.1%, p=0.01).
Conclusions:
- Targeted QI interventions are highly effective in reducing admission hypothermia among VLBW infants.
- Implementing a comprehensive 'temperature bundle' can significantly improve clinical outcomes, including survival rates.
- These findings highlight the importance of standardized hypothermia prevention protocols in neonatal care.
Background:
Hypothermia is a common problem that is associated with increased mortality and morbidity among preterm infants, especially in China. The objective of this study was to evaluate the efficacy of a targeted quality improvement (QI) project that applied hypothermia prevention measures for very-low-birth-weight (VLBW) infants in three tertiary neonatal intensive care units (NICUs) in China.
Problem:
Between January 2018 and December 2018, we conducted a prospective analysis and found that the incidence of AH was 88.2% among VLBW infants.
Methods:
The study enrolled preterm infants born at less than 32 weeks' gestation with a VLBW of less than 1500 g who were delivered at three academic tertiary-care hospitals between January 2018 and December 2019. The primary outcome measure was the incidence of hypothermia. The outcomes of the pre-QI group (1 January-31 December 2018) were compared with those of the post-QI group (1 January-31 December 2019).
Interventions:
Based on the literature, our preliminary findings and the needs of each unit, a temperature bundle that included a transport incubator, prewarmed hats, polyethylene wrap, team training and education, and temperature documentation and workflows were implemented in consecutive plan-do-study-act cycles.
Results:
Of the 530 VLBW infants, 235 infants (36.9%) belonged to the pre-QI group, and 295 infants (46.4%) belonged to the post-QI group. The incidence of hypothermia decreased significantly, from 92.3% to 62% (p<0.001), and the mean body temperature on admission to the NICU increased significantly, from 35.5°C to 36°C±0.7°C (p<0.001). There was one case of hyperthermia during the study period. Infants in the post-QI group had a lower mortality rate (16.1% vs 8.8%, p=0.01).
Conclusions:
Targeted interventions can dramatically reduce admission hypothermia and improve the outcome of VLBW infants in China.
Trial Registration Number:
Chi CTR 1900020861.
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