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

被引:20
作者
Yip, Wai Yan [1 ]
Quek, Bin Huey [1 ]
Fong, Mary Choi Wan [2 ]
Thilagamangai [2 ]
Ong, Sally Siew Gim [2 ]
Lim, Bee Leong [2 ]
Lo, Bo Chu [2 ]
Agarwal, Pratibha [1 ,3 ]
机构
[1] KK Womens & Childrens Hosp, Dept Neonatol, 100 Bukit Timah Rd, Singapore 229899, Singapore
[2] KK Womens & Childrens Hosp, Div Nursing, 100 Bukit Timah Rd, Singapore 229899, Singapore
[3] KK Womens & Childrens Hosp, Dept Child Dev, 100 Bukit Timah Rd, Singapore 229899, Singapore
关键词
hypothermia; preterm; very low birth weight infants; quality improvement; BIRTH-WEIGHT INFANTS; RANDOMIZED CONTROLLED-TRIAL; DELIVERY ROOM; PREMATURE-INFANTS; EXOTHERMIC MATTRESSES; POLYETHYLENE BAGS; RISK-FACTORS; TEMPERATURE; NEWBORNS; OUTCOMES;
D O I
10.1093/intqhc/mzx131
中图分类号
R19 [保健组织与事业(卫生事业管理)];
学科分类号
摘要
To study effectiveness of quality improvement interventions in reducing hypothermia in preterm infants on admission to neonatal intensive care unit. Quality improvement methodologies including multidisciplinary planning and implementation of evidence-based interventions. Data during and post-implementation were collected. 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. 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. Primary outcome was incidence of hypothermia and mean admission temperature. Secondary outcomes were rates of intraventricular haemorrhage and mortality. 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 +/- 0.8A degrees C to 36.5 +/- 0.7A degrees 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. 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.
引用
收藏
页码:922 / 928
页数:7
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