Improving Admission Temperature in Infants ≥34 Weeks' Gestation: A Quality Improvement Initiative

Area of Science:

• Neonatal Medicine
• Pediatrics
• Quality Improvement Science

Background:

• Neonatal hypothermia is a significant global health issue, particularly affecting infants born at or after 34 weeks gestational age (GA).
• Existing research has largely overlooked interventions for this specific infant population, despite the high incidence of births at this GA.
• Hypothermia on NICU admission leads to increased morbidity, mortality, and healthcare costs.

Purpose of the Study:

• To enhance the proportion of infants born at ≥34 weeks GA who are normothermic upon NICU admission.
• To improve the rate of normal body temperature in all infants born at ≥34 weeks GA in the delivery room.
• To assess the impact of interventions on secondary outcomes, including hypoglycemia and metabolic acidosis.

Main Methods:

• A comprehensive root cause analysis, employing fishbone diagrams and process mapping, identified key factors contributing to hypothermia.
• Plan-do-study-act (PDSA) cycles were utilized to test and implement a series of interventions.
• A standardized operating procedure was developed for vaginal and cesarean section births, with outcome measures analyzed using P-charts and traditional statistical methods.

Main Results:

• The proportion of infants born at ≥34 weeks GA with normothermia on NICU admission increased significantly from 62% to 80%, without an increase in hyperthermia.
• Interventions also improved the rate of normothermia in the delivery room for all infants born at ≥34 weeks GA.
• A reduction in the need for intravenous therapy for hypoglycemia and a decreased incidence of metabolic acidosis were observed.

Conclusions:

• The quality improvement initiative effectively improved normothermia rates for infants at the institution.
• The implemented methodology offers a scalable approach for other centers facing similar challenges with neonatal hypothermia.
• Successful interventions contribute to better neonatal outcomes and potentially reduced healthcare burdens.