Skip to main content

Thank you for visiting You are using a browser version with limited support for CSS. To obtain the best experience, we recommend you use a more up to date browser (or turn off compatibility mode in Internet Explorer). In the meantime, to ensure continued support, we are displaying the site without styles and JavaScript.

Quality Improvement

Implementation of a multidisciplinary guideline improves preterm infant admission temperatures



Hypothermia is a common problem in preterm infants immediately following delivery.

Local problem:

The rate of admission hypothermia in our neonatal intensive care unit (NICU) was above the rate of comparable NICUs in the Vermont Oxford Network.


To reduce the rate of preterm admission hypothermia, a quality improvement (QI) project was implemented, utilizing the plan-do-study-act (PDSA) methodology. A guideline for delivery room thermoregulation management in <35-week infants at the University of Virginia was created and put into practice by a multidisciplinary team.


Clinical practice changes in the guideline included: increasing operating room temperatures, obtaining a 10-min axillary temperature, using an exothermic mattress for all infants <35 weeks, and using a polyethylene wrap for infants <32 weeks.


The baseline rate of hypothermia (<36.5 °CC) was 63%. Three PDSA cycles data were completed on 168 consecutive preterm births. The post-implementation rate of hypothermia (<36.5 °C) was reduced to 30% (P<0.001). The incidence of moderate hypothermia (< 36 °C) was reduced from a baseline of 29% to a rate of 9% (P<0.001).


Use of a multidisciplinary guideline to increase preterm NICU admission temperatures resulted in a decrease in hypothermic infants.

Access options

Rent or Buy article

Get time limited or full article access on ReadCube.


All prices are NET prices.

Figure 1
Figure 2
Figure 3


  1. 1

    Miller SS, Lee HC, Gould JB . Hypothermia in very low birth weight infants: distribution, risk factors and outcomes. J Perinatol 2011; 31 (Suppl 1 (S1): S49–S56.

    Article  Google Scholar 

  2. 2

    Ringer SA . Core concepts: thermoregulation in the newborn part I: basic mechanisms. Neoreviews 2013; 14 (4): e161–e167.

    Article  Google Scholar 

  3. 3

    Ringer SA . Core concepts: thermoregulation in the newborn, part II: prevention of aberrant body temperature. Neoreviews 2013; 14 (5): e221–e226.

    Article  Google Scholar 

  4. 4

    Laptook AR, Salhab W, Bhaskar B . Admission temperature of low birth weight infants: predictors and associated morbidities. Pediatrics 2007; 119 (3): e643–e649.

    Article  Google Scholar 

  5. 5

    de Almeida MFB, Guinsburg R, Sancho GA, Rosa IRM, Lamy ZC, Martinez FE et al. Hypothermia and early neonatal mortality in preterm infants. J Pediatr 2014; 164 (2): 271–5.e1.

    Article  Google Scholar 

  6. 6

    Lyu Y, Shah PS, Ye XY, Warre R, Piedboeuf B, Deshpandey A et al. Association between admission temperature and mortality and major morbidity in preterm infants born at fewer than 33 weeks’ gestation. JAMA Pediatr 2015; 169 (4): e150277.

    Article  Google Scholar 

  7. 7

    Zaichkin J, Kattwinkel J, McGowan J . American Heart Association, American Academy of Pediatrics Textbook of Neonatal Resuscitation,6th edn. American Academy of Pediatrics: Elk Grove Village, IL,2011.

  8. 8

    Jia Y-S, Lin Z-L, Lv H, Li Y-M, Green R, Lin J . Effect of delivery room temperature on the admission temperature of premature infants: a randomized controlled trial. J Perinatol 2013; 33 (4): 264–267.

    Article  Google Scholar 

  9. 9

    McCall EM, Alderdice F, Halliday HL, Jenkins JG, Vohra S . Interventions to prevent hypothermia at birth in preterm and/or low birthweight infants. Cochrane database Syst Rev 2010; 17 (3): CD004210.

    Google Scholar 

  10. 10

    Leadford AE, Warren JB, Manasyan A, Chomba E, Salas AA, Schelonka R et al. Plastic bags for prevention of hypothermia in preterm and low birth weight infants. Pediatrics 2013; 132 (1): e128–e134.

    Article  Google Scholar 

  11. 11

    Chawla S, Amaram A, Gopal SP, Natarajan G . Safety and efficacy of Trans-warmer mattress for preterm neonates: results of a randomized controlled trial. J Perinatol 2011; 31 (12): 780–784.

    CAS  Article  Google Scholar 

  12. 12

    Russo A, McCready M, Torres L, Theuriere C, Venturini S, Spaiǵht M et al. Reducing hypothermia in preterm infants following delivery. Pediatrics 2014; 133 (4): e1055–e1062.

    Article  Google Scholar 

  13. 13

    McCarthy LK, Molloy EJ, Twomey AR, Murphy JFA, O’Donnell CPF . A randomized trial of exothermic mattresses for preterm newborns in polyethylene bags. Pediatrics 2013; 132 (1): e135–e141.

    Article  Google Scholar 

  14. 14

    DeMauro SB, Douglas E, Karp K, Schmidt B, Patel J, Kronberger A et al. Improving delivery room management for very preterm infants. Pediatrics 2013; 132 (4): e1018–e1025.

    Article  Google Scholar 

  15. 15

    Manani M, Jegatheesan P, DeSandre G, Song D, Showalter L, Govindaswami B . Elimination of admission hypothermia in preterm very low-birth-weight infants by standardization of delivery room management. Perm J 2013; 17 (3): 8–13.

    Article  Google Scholar 

  16. 16

    Weiner GM, Zaichkin J, Kattwinkel J,American Academy of Pediatrics, American Heart AssociationTextbook of neonatal resuscitation, 7th Edition.American Academy of Pediatrics: Elk Grove Village, IL, 2016

Download references

Author information



Corresponding author

Correspondence to M W Harer.

Ethics declarations

Competing interests

The authors declare no conflict of interest.

Rights and permissions

Reprints and Permissions

About this article

Verify currency and authenticity via CrossMark

Cite this article

Harer, M., Vergales, B., Cady, T. et al. Implementation of a multidisciplinary guideline improves preterm infant admission temperatures. J Perinatol 37, 1242–1247 (2017).

Download citation


Quick links