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. 2017 Nov 1;29(7):922-928.
doi: 10.1093/intqhc/mzx131.

A quality improvement project to reduce hypothermia in preterm infants on admission to the neonatal intensive care unit

Wai Yan Yip  1 , Bin Huey Quek  1 , Mary Choi Wan Fong  2 , Thilagamangai  2 , Sally Siew Gim Ong  2 , Bee Leong Lim  2 , Bo Chu Lo  2 , Pratibha Agarwal  1   3
Affiliations

A quality improvement project to reduce hypothermia in preterm infants on admission to the neonatal intensive care unit

Wai Yan Yip et al. Int J Qual Health Care. .

Abstract

Objective: To study effectiveness of quality improvement interventions in reducing hypothermia in preterm infants on admission to neonatal intensive care unit.

Design: Quality improvement methodologies including multidisciplinary planning and implementation of evidence-based interventions. Data during and post-implementation were collected.

Setting and participants: In total, 84 preterm infants with birth weights ≤ 1500 g delivered during implementation period (October 2008-April 2009) were compared with 168 historical controls and 947 infants in the subsequent 4 years.

Intervention(s): In addition to routine interventions, delivery room temperatures were increased, and use of full-body polyethylene wraps and woollen caps were implemented during initial stabilization. Education and training were provided to reinforce the new interventions.

Main outcome measure(s): Primary outcome was incidence of hypothermia and mean admission temperature. Secondary outcomes were rates of intraventricular haemorrhage and mortality.

Results: Incidence of admission hypothermia decreased from 79.4 to 40.5% (P < 0.001), constituting a 49% improvement (OR = 0.177, 95% CI: 0.099-0.316). Mean admission temperature increased from 35.8 ± 0.8°C to 36.5 ± 0.7°C (P < 0.001). Hyperthermia incidence was higher at 6% compared to baseline of 1.3% (P = 0.049). The incidence of admission hypothermia remained stable at 47.4% in the 4 years post-implementation. Rates of intraventricular haemorrhage and mortality remained unchanged. Small for gestation, low 5-min Apgar score and singleton delivery were factors found to be associated with admission hypothermia.

Conclusion: The implementation of evidence-based best practices resulted in significant reduction in admission hypothermia in preterm infants, which persisted for 4 years post-implementation. The practices have since become standard of care in our institution.

Keywords: hypothermia; preterm; quality improvement; very low birth weight infants.

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