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

Guichao Zhong1, Jie Qi1, Lijuan Sheng1

  • 1Department of Neonatology, Shenzhen People's Hospital (The Second Clinical Medical College, Jinan University; The First Affiliated Hospital, Southern University of Science and Technology), Shenzhen, Guangdong, China.

Peerj
|November 5, 2024
PubMed

Insights

Quality improvement bundles reduce hypothermia in very low birth weight (VLBW) and extremely low birth weight (ELBW) infants. However, these interventions may increase the risk of hyperthermia, particularly in VLBW infants.

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.
Abstract

Keywords:
Extremely low birth weight infantsHypothermiaMeta-analysisQuality improvementVery low birth weight infants

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