We thank Dr Heuchan and Dr Goldman for their interest and comments on our paper as well as their insight in identifying the important role of monitoring and maintaining ambient temperatures of above 25 °C in improving admission temperatures of preterm newborns. We commend Dr Heuchan and her colleagues for their persistence and success in dramatically improving admission temperatures of newborns in their neonatal intensive care unit through their quality improvement programs.
Their results highlight the challenges of translating findings from clinical trial settings, which inherently represent highly controlled environments, to the proverbial bedside, wherein multiple environmental forces impart their weighted influences on health outcomes. In this particular case, there were disparate results from two neonatal intensive care units despite implementing similar if not identical protocols. This difference may be explained by their second measure of maintaining ambient temperatures of above 25 °C; we did not examine ambient temperatures in our study. It is also notable that our population had a higher proportion (76%) of patients with admission temperatures of <36 °C before the quality improvement project. It is possible because of the larger room for improvement in our cohort, the other interventions to elevate neonatal admission temperatures were more effective in our environment. The ambient room temperatures in our delivery and operating rooms are generally set to the preference of the delivering mothers and to health-care professionals—regulating these temperatures may allow for further improvement in preventing newborn hypothermia in preterm infants in our environment.
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