Quality improvement bundles to decrease hypothermia in very low/extremely low birth weight infants at birth: a...

Area of Science:

• Neonatal care
• Pediatric quality improvement
• Perinatal medicine

Background:

• Hypothermia in preterm infants, especially those with very low or extremely low birth weights (VLBW/ELBW), is linked to increased morbidity and mortality.
• Healthcare facilities are increasingly adopting quality improvement (QI) bundles to mitigate hypothermia at birth in this vulnerable population.
• The efficacy and safety of these QI bundles require thorough assessment.

Purpose of the Study:

• To evaluate the effectiveness of QI bundles in reducing hypothermia at birth among VLBW/ELBW infants.
• To assess the safety of QI bundles, specifically examining the incidence of hyperthermia.

Main Methods:

• A comprehensive literature search was conducted across PubMed, Embase, Cochrane Library, and Web of Science up to April 22nd, 2024.
• Study selection, data extraction, and risk of bias assessment were performed independently by two investigators.
• Meta-analysis was conducted using Review Manager 5.4.1, including 18 studies for qualitative analysis and 12 for quantitative meta-analysis.

Main Results:

• For VLBW infants, QI bundles significantly reduced mild and moderate hypothermia (OR 0.22, 95% CI [0.13-0.37]; OR 0.18, 95% CI [0.15-0.22], respectively) but increased hyperthermia (OR 2.79, 95% CI [1.53-5.09]).
• For ELBW infants, QI bundles decreased mild and moderate hypothermia (OR 0.46, 95% CI [0.26-0.81]; OR 0.21, 95% CI [0.08-0.58], respectively) with no significant increase in hyperthermia (OR 1.10, 95% CI [0.22-5.43]).

Conclusions:

• QI bundles are effective in reducing hypothermia in both VLBW and ELBW infants.
• A potential increase in hyperthermia, particularly in VLBW infants, necessitates careful monitoring and consideration when implementing QI bundles.