Reducing Hypothermia in Preterm Infants Following Delivery

BACKGROUND:Moderate hypothermia (temperature <36 degrees C) at birth is common in premature infants and is associated with increased mortality and morbidity.METHODS:A multidisciplinary practice plan was implemented to determine in premature infants <35 weeks old whether a multifaceted approach would reduce the number of inborn infants with an admitting axillary temperature <36 degrees C by 20% without increasing exposure to a temperature >37.5 degrees C. The plan included use of occlusive wrap a transwarmer mattress and cap for all infants and maintaining an operating room temperature between 21 degrees C and 23 degrees C. Data were obtained at baseline (n = 66), during phasing in (n = 102), and at full implementation (n = 193).RESULTS:Infant axillary temperature in the delivery room (DR) increased from 36.1 degrees C 0.6 degrees C to 36.2 degrees C +/- 0.6 degrees C to 36.6 degrees C +/- 0.6 degrees C (P < .001), and admitting temperature increased from 36.0 degrees C +/- 0.8 degrees C to 36.3 degrees C +/- 0.6 degrees C to 36.7 degrees C +/- 0.5 degrees C at baseline, phasing in, and full implementation, respectively (P < .001). The number of infants with temperature <36 degrees C decreased from 55% to 6.2% at baseline versus full implementation (P < .001), and intubation at 24 hours decreased from 39% to 17.6% (P = .005). There was no increase in the number of infants with a temperature >37.5 degrees C over time. The use of occlusive wrap, mattress, and cap increased from 33% to 88% at baseline versus full implementation. Control charts showed significant improvement in DR ambient temperature at baseline versus full implementation.CONCLUSIONS:The practice plan was associated with a significant increase in DR and admitting axillary infant temperatures and a corresponding decrease in the number of infants with moderate hypothermia. There was an associated reduction in intubation at 24 hours. These positive findings reflect increased compliance with the practice plan.