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Quality Improvement

Implementation of a multidisciplinary guideline improves preterm infant admission temperatures

Abstract

Background:

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.

Methods:

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.

Interventions:

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.

Results:

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).

Conclusion:

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

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Correspondence to M W Harer.

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Harer, M., Vergales, B., Cady, T. et al. Implementation of a multidisciplinary guideline improves preterm infant admission temperatures. J Perinatol 37, 1242–1247 (2017). https://doi.org/10.1038/jp.2017.112

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