Quality Improvement Article | Published:

Quality Improvement

Implementation of a multidisciplinary guideline improves preterm infant admission temperatures

Journal of Perinatology volume 37, pages 12421247 (2017) | Download Citation

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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Author information

Author notes

    • M W Harer

    Current address: Division of Neonatology, Department of Pediatrics, University of Wisconsin School of Medicine and Public Health, Madison, WI, USA.

Affiliations

  1. Division of Neonatology, Department of Pediatrics, University of Virginia, Charlottesville, VA, USA

    • M W Harer
    • , B Vergales
    •  & J R Swanson
  2. Neonatal Intensive Care Unit, University of Virginia, Charlottesville, VA, USA

    • T Cady
    •  & A Early
  3. Division of Maternal Fetal Medicine, Department of Obstetrics and Gynecology, University of Virginia, Charlottesville, VA, USA

    • C Chisholm

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Competing interests

The authors declare no conflict of interest.

Corresponding author

Correspondence to M W Harer.

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DOI

https://doi.org/10.1038/jp.2017.112