Implementation of a multidisciplinary guideline improves preterm infant admission temperatures

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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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