Avoiding Hypothermia in Preterm Infants

Background: Preterm neonates are predisposed to develop hypothermia. Admission temperatures below 36°C are associated with increased mortality and morbidity.

Objective: To increase compliance of preterm infants’ 32 weeks gestation having admission temperatures 36.5C-37.5C, as per NNAP standard, by preventing heat loss in the immediate postnatal period. Prior to this project our Unit’s compliance was 59%. Initially we targeted compliance of 75%.

Methods: We used the rapid-cycle Plan-Do-Study-Act method. Preterm infants less than 32 weeks gestation who were born at a Regional Neonatal Intensive Care Unit (University College Hospital – UCH, London, England) were enrolled.

Our intervention involved a new education programme and standardising the management at delivery with a thermoregulation guideline (including use of transwarmer, plastic bag and hat). Importantly a major change involved increasing the ambient temperature in theatres to 26C (previously 23C) for those born in obstetric theatres.

Weekly data on admission temperature were collected prospectively.

Results: Over the 9 weeks that the project has been running 21 32w gestation infants were born at UCH.

17 (81%) achieved admission temperatures of 36.5C - 37.5C

Only 1 infant had an admission temperature 37.5C (37.7C) and they were septic.

16 of the infants were admitted from obstetric theatres; 13 achieved admission temperatures in range (81.3%) by adhering fully to our new guideline. Of the 3 that did not, all were hypothermic (36.5C), and in each case the theatre temperature was not increased to 26C (only 23-24C), although the rest of our guideline was followed.

Conclusion: We reduced hypothermia in 32w gestation infants using a standardised guideline, and educating and involving the whole multidisciplinary team. Increasing ambient temperature in operating theatres is vital to avoid hypothermia. The PDSA cycles and weekly audits allowed for real time feedback helping to sustain the improvement. Moving forward we aim to target compliance of 90%.