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Improving thermoregulation in transported preterm infants: a quality improvement initiative

Journal of Perinatology volume 41, pages 339–345 (2021)Cite this article

Subjects

Abstract

Objective

Increase the percentage of transported preterm or LBW infants with an admission temperature of 36.5–37.5 °C from 60 to 80% by December 2017.

Study design

We used the Model for Improvement with Plan-Do-Study-Act (PDSA) cycles. Interventions focused on awareness of temperature control in preterm infants, adequate monitoring, and maintaining normothermia. Interventions consisted of standardizing isolette temperature, use of chemical warming pack and plastic wrap, and feedback. Data were plotted on a p-chart and grouped by month.

Result

A total of 381 infants <37 weeks or <2.5 kg were transported from January 2016 to December 2019. At baseline 60% were admitted with a temperature within the range of 36.5–37.5 °C. Special cause variation was noted twice during the study period, initially to 80% in June 2018 and then to 96% in April 2019, without an increase in hyperthermia.

Conclusion

Multidisciplinary quality improvement efforts improved normothermia in vulnerable transported infants to 96%.

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References

  1. Costeloe K, Hennessy E, Gibson AT, Marlow N, Wilkinson AR. The EPICure study: outcomes to discharge from hospital for infants born at the threshold of viability. Pediatrics. 2000;106:659–71.

    Article  CAS  Google Scholar 

  2. Laptook AR, Salhab W, Bhaskar B, Network NR. Admission temperature of low birth weight infants: predictors and associated morbidities. Pediatrics. 2007;119:e643–9.

    Article  Google Scholar 

  3. Miller SS, Lee HC, Gould JB. Hypothermia in very low birth weight infants: distribution, risk factors and outcomes. J Perinatol. 2011;31:S49–56.

    Article  Google Scholar 

  4. Martin RJ, Fanaroff AA, Walsh MC. Fanaroff and Martin’s neonatal-perinatal medicine: diseases of the fetus and infant. 10th ed. Philadelphia, PA: Elsevier/Saunders; 2015. xxiv, 833 pages (I1-I65 pages) p.

  5. Chang HY, Sung YH, Wang SM, Lung HL, Chang JH, Hsu CH, et al. Short- and long-term outcomes in very low birth weight infants with admission hypothermia. PLoS One. 2015;10:e0131976.

    Article  Google Scholar 

  6. Russo A, McCready M, Torres L, Theuriere C, Venturini S, Spaight M, et al. Reducing hypothermia in preterm infants following delivery. Pediatrics. 2014;133:e1055–62.

    Article  Google Scholar 

  7. McNellis EM, Leonard AR, Thornton KA, Voos KC. Improving thermal support in very and extremely low birth weight infants during interfacility transport. Pediatr Qual Saf. 2019;4:e170.

    Article  Google Scholar 

  8. Leng H, Wang H, Lin B, Cheng G, Wang L. Reducing transitional hypothermia in outborn very low birth weight infants. Neonatology 2016;109:31–6.

    Article  Google Scholar 

  9. Knobel R, Holditch-Davis D. Thermoregulation and heat loss prevention after birth and during neonatal intensive-care unit stabilization of extremely low-birthweight infants. Adv Neonatal Care. 2010;10:S7–14.

    Article  Google Scholar 

  10. 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:CD004210. https://doi.org/10.1002/14651858.CD004210.pub4.

  11. Pinheiro JM, Furdon SA, Boynton S, Dugan R, Reu-Donlon C, Jensen S. Decreasing hypothermia during delivery room stabilization of preterm neonates. Pediatrics. 2014;133:e218–26.

    Article  Google Scholar 

  12. Chien LY, Whyte R, Aziz K, Thiessen P, Matthew D, Lee SK, et al. Improved outcome of preterm infants when delivered in tertiary care centers. Obstet Gynecol. 2001;98:247–52.

    CAS  PubMed  Google Scholar 

  13. Knobel RB, Vohra S, Lehmann CU. Heat loss prevention in the delivery room for preterm infants: a national survey of newborn intensive care units. J Perinatol. 2005;25:514–8.

    Article  Google Scholar 

  14. Harris PA, Taylor R, Thielke R, Payne J, Gonzalez N, Conde JG. Research electronic data capture (REDCap)–a metadata-driven methodology and workflow process for providing translational research informatics support. J Biomed Inf. 2009;42:377–81.

    Article  Google Scholar 

  15. Harris PA, Taylor R, Minor BL, Elliott V, Fernandez M, O’Neal L, et al. The REDCap consortium: Building an international community of software platform partners. J Biomed Inf. 2019;95:103208.

    Article  Google Scholar 

  16. Lunze K, Bloom DE, Jamison DT, Hamer DH. The global burden of neonatal hypothermia: systematic review of a major challenge for newborn survival. BMC Med. 2013;11:24.

    Article  Google Scholar 

  17. Lunze K, Hamer DH. Thermal protection of the newborn in resource-limited environments. J Perinatol. 2012;32:317–24.

    Article  CAS  Google Scholar 

  18. Belsches TC, Tilly AE, Miller TR, Kambeyanda RH, Leadford A, Manasyan A, et al. Randomized trial of plastic bags to prevent term neonatal hypothermia in a resource-poor setting. Pediatrics. 2013;132:e656–61.

    Article  Google Scholar 

  19. World Health Organization MaNHSM. Thermal protection of the newborn: a practical guide. In: Geneva: Maternal and Newborn Health/Safe Motherhood Unit DoRHTS, World Health Organization 1997.

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Acknowledgements

We acknowledge the critical care transport team members who were essential to this quality improvement effort, as well as the NICU staff who supported the project. We also acknowledge the caregivers at outlying hospitals who contributed to improvement efforts in thermoregulation for preterm infants prior to the arrival of the critical care transport team. We especially acknowledge the crucial work of Dr. Melanie Stempowski, MD; Deb Skoglund, RN, MSN; Susan Dornan, RN; and Dr. Ganga Srinivas, MD; in actualizing the interventions within the context of individual hospitals.

Funding

Support for REDCap (Research Electronic Data Capture) Provided by: CTSC grant (1 UL1 RR024989 from NCRR/NIH)

Author information

Authors and Affiliations

  1. Department of Pediatrics, University Hospitals Rainbow Babies and Children’s Hospital, Cleveland, OH, USA

    Tara Glenn, Lauren Culbertson & Gulgun Yalcinkaya

  2. Department of Emergency Services, University Hospitals Cleveland Medical Center, Cleveland, OH, USA

    Rhonda Price

  3. Department of Pediatrics, Oregon Health and Science University, Portland, OR, USA

    Lauren Culbertson

Authors
  1. Tara Glenn
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  2. Rhonda Price
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  3. Lauren Culbertson
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  4. Gulgun Yalcinkaya
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Contributions

TG conceptualized the project, collected data, planned interventions, evaluated the success of each PDSA cycle, and drafted and revised the final manuscript. RP assisted with implementing interventions, providing feedback on each intervention, evaluated all data points outside of goal range, and revised the final manuscript. LC assisted with data collection, planning and assessing interventions, and revised the final manuscript. GY supervised the project, assisted with planning the initial project, assisted with planning and assessing interventions, and revised the final manuscript.

Corresponding author

Correspondence to Tara Glenn.

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The authors declare that they have no conflict of interest.

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Glenn, T., Price, R., Culbertson, L. et al. Improving thermoregulation in transported preterm infants: a quality improvement initiative. J Perinatol 41, 339–345 (2021). https://doi.org/10.1038/s41372-020-0732-z

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  • DOI: https://doi.org/10.1038/s41372-020-0732-z

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