Implementation of a multidisciplinary guideline improves preterm infant admission temperatures

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 degrees CC) was 63%. Three PDSA cycles data were completed on 168 consecutive preterm births. The post-implementation rate of hypothermia (< 36.5 degrees C) was reduced to 30% (P < 0.001). The incidence of moderate hypothermia (< 36 degrees 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.