The impact of a quality improvement effort in reducing admission hypothermia in preterm infants following delivery

• Published in: Clinical and experimental pediatrics Vol. 61; no. 8; pp. 239 - 244
• Main Authors: Choi, Han Saem, Lee, Soon Min, Eun, Hoseon, Park, Minsoo, Park, Kook-In, Namgung, Ran
• Format: Journal Article
• Language: English
• Published: Korea (South) Clinical and Experimental Pediatics / Korean Pediatric Society 01.08.2018; Korean Pediatric Society; 대한소아청소년과학회
• Subjects: Birth weight; Body temperature; Fever; Gestational age; Heat; Hyperthermia; Hypothermia; Intensive care; Morbidity; Mortality; Multidisciplinary teams; Newborn babies; Original; Premature babies; Preterm infants; Pulmonary haemorrhage; Quality improvement; Respiratory distress syndrome; Sepsis; Very low birth weight infants; 소아과학; United States > US; Pulmonary haemorrhage; Quality improvement; Very low birth weight infants; Preterm infants; Hypothermia
• ISSN: 1738-1061; 2092-7258; 2713-4148
• DOI: 10.3345/kjp.2018.61.8.239

Hypothermia at admission is associated with increased mortality and morbidity in preterm infants. We performed a quality improvement (QI) effort to determine the impact of a decrease in admission hypothermia in preterm infants. The study enrolled very low birth weight (VLBW) infants born at Gangnam Severance Hospital between January 2013 and December 2016. This multidisciplinary QI effort included the use of occlusive wraps, warm blankets, and caps; the delivery room temperature was maintained above 23.0˚C, and a check-list was used for feedback. Among 259 preterm infants, the incidence of hypothermia (defined as body temperature <36.0˚C) decreased significantly from 68% to 41%, and the mean body temperature on neonatal intensive care unit admission increased significantly from 35.5˚C to 36.0˚C. In subgroup analysis of VLBW infants, admission hypothermia and neonatal outcomes were compared between the pre-QI (n=55) and post-QI groups (n=75). Body temperature on admission increased significantly from 35.4˚C to 35.9˚C and the number of infants with hypothermia decreased significantly from 71% to 45%. There were no cases of neonatal hyperthermia. The incidence of pulmonary hemorrhage was significantly decreased (P=0.017). Interaction analysis showed that birth weight and gestational age were not correlated with hypothermia following implementation of the protocol. Our study demonstrated a significant reduction in admission hypothermia following the introduction of a standardized protocol in our QI effort. This resulted in an effective reduction in the incidence of massive pulmonary hemorrhage.