Implementation Of a Multidisciplinary Guideline Improves Preterm Infant …

Harer MW, Vergales B, Cady T, Early A, Chisholm C, Swanson JR. Implementation of a multidisciplinary guideline improves preterm infant admission temperatures. J Perinatol. 2017 Nov;37(11):1242-1247. doi: 10.1038/jp.2017.112. Epub 2017 Jul 20. PubMed PMID: 28726791.

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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