Abstract
This prospective observational study was aimed to analyze the impact of a quality improvement project to reduce admission hypothermia on composite outcome of neonatal mortality and major morbidities. Infants with birth weight between 500 and 1499 g and gestation ≥ 25 weeks without major congenital malformations delivered between January 2018 and January 2020 who were admitted directly from delivery room to NICU were included in the study. Study period was divided in three phases including pre-intervention, intervention and post-intervention phase. There were a total of 368 VLBW infants included in the study. Mean admission temperature of neonates was 35.3 ± 0.6 °C, 36.0 ± 0.8 °C, and 36.4 ± 0.4 °C during pre-intervention, intervention, and post-intervention phase, respectively. Absolute incidence of composite outcome was 31%, 20%, and 13.2% during pre-intervention, intervention, and post-intervention phase, respectively. Risk of adverse composite outcome was significantly lower in post-intervention period as compared to pre-intervention period (aRR 0.68, 95% CI 0.49–0.92). Nosocomial sepsis and need for invasive ventilation was also significantly less in post-intervention period as compared to pre-intervention period.
Conclusion: Implementation of thermoregulatory interventions best suited to local settings help in significant reduction of neonatal hypothermia, which in turn can help to improve neonatal outcomes.
What is known: • Admission hypothermia is associated with adverse neonatal outcomes. • Implementation of quality improvement projects help reducing hypothermia incidence. | |
What is new: • Implementation of quality improvement project to reduce admission hypothermia resulted in reduction in incidence of adverse composite neonatal outcome. • Also implementation of quality improvement project led to reduction in incidence of nosocomial sepsis and need of invasive ventilation. |
Similar content being viewed by others
Abbreviations
- DR:
-
Delivery room
- ELBW:
-
Extremely low birth weight
- IVH:
-
Intraventricular hemorrhage
- NEC:
-
Necrotizing enterocolitis
- NICU:
-
Neonatal intensive care unit
- QI:
-
Quality improvement,
- VLBW:
-
Very low birth weight
References
Laptook AR, Salhab W, Bhaskar B (2007) Admission temperature of low birth weight infants: predictors and associated morbidities. Pediatrics. 119:e643–e649
Bailey J, Rose P (2000) Temperature measurement in the preterm infant: a literature review. J Neonatal Nurs 6:28–32
Bissinger RL, Annibale DJ (2010) Thermoregulation in very low birth weight infants during the golden hour: results and implications. Adv Neonatal Care 10:230–238
Organization WH (1993) Thermal protection of the newborn: a practical guide. Switzerland, Geneva
Miller S, Lee H, Gould J (2011) Hypothermia in very low birth weight infants: distribution, risk factors and outcomes. J Perinatol 31:49–56
Harms K, Herting E, Kron M, Schill N, Schiffmann H (1997) Importance of pre and perinatal risk factors in respiratory distress syndrome of premature infants. A logical regression analysis of 1100 cases. Z GeburtshilfeNeonatol 201:258–262
American Academy of Pediatrics (AAP) and American College of Obstetricians and Gynecologists (ACOG) (2012) Guidelines for Perinatal Care, 7th edn. American Academy of Pediatrics, Elk Grove Village
Choi HS, Lee SM, Eun H, Park M, Park K-I, Namgung R et al (2018) The impact of a quality improvement effort in reducing admission hypothermia in preterm infants following delivery. Korean J Pediatr 61(8):239–244
Lee HC, Ho QT, Rhine WD et al (2008) A quality improvement project to improve admission temperatures in very low birth weight infants. J Perinatol 28:754–758. https://doi.org/10.1038/jp.2008.92
Harer MW, Vergales B, Cady T, Early A, Chisholm C, Swanson JR et al (2017) Implementation of a multidisciplinary guideline improves preterm infant admission temperatures. J Perinatol 00:1–6
Fenton TR, Kim JH (2013) A systematic review and meta-analysis to revise the Fenton growth chart for preterm infants. BMC Pediatr 13:59
Papile LA, Burstein J, Burstein R, Koffler H (1978) Incidence and evolution of subependymal and intraventricular hemorrhage: a study of infants with birth weights less than 1,500 gm. J Pediatr 92(4):529–534
Bell MJ, Ternberg JL, Feigin RD et al (1978) Neonatal necrotizing enterocolitis: therapeutic decisions based upon clinical staging. Ann Surg 187(1):1–7
Adamkin DH (2011) Clinical Report—Postnatal Glucose Homeostasis in late-preterm and term infants. Pediatrics peds-2010
Sivanandan S, Sethi A, Joshi M, Thukral A, Sankar MJ, Deorari AK, Agarwal R (2018) Gains from quality improvement initiatives – experience from a tertiary-care institute in India. Indian Pediatr 55:809–817
Datta V, Saili A, Goel S et al (2017) Reducing hypothermia in newborns admitted to a neonatal care unit in a large academic hospital in New Delhi, India. BMJ Open Quality 6:e000183. https://doi.org/10.1136/bmjoq-2017-000183
Frazer M, Ciarlo A, Herr J, Briere C-E et al (2018) Quality improvement initiative to prevent admission hypothermia in very-low-birth-weight newborns. J Obstet Gynecol Neonatal Nurs 47(4):520–528
O’Brien EA, Colaizy TT, Brumbaugh JE, Cress GA, Johnson KJ, Klein JM, Bell EF (2019) Body temperatures of very low birth weight infants on admission to a neonatal intensive care unit. J Matern Fetal Neonatal Med 32(16):2763–2766
Lyu Y, Shah PS, Ye XY et al (2015) Association between admission temperature and mortality and major morbidity in preterm infants born at fewer than 33 weeks’ gestation. JAMA Pediatr 169(4):e150277.20
Manani M, Jegatheesan P, DeSandre G, Song D, Showalter L, Govindaswami B (2013) Elimination of admission hypothermia in preterm very low-birth-weight infants by standardization of delivery room management. Perm J 17(3):8–13
DeMauro SB, Douglas E, Karp K, Schmidt B, Patel J, Kronberger A et al (2013) Improving delivery room management for very preterm infants. Pediatrics 132(4):e1018–e1025
Andrews C, Whatley C, Smith M, Brayton EC, Simone S, Holmes AV (2018) Quality-improvement effort to reduce hypothermia among high-risk infants on a mother-infant unit. Pediatrics. 141(3):e20171214
Yip WY, Quek BH, Fong MCW et al (2017) A quality improvement project to reduce hypothermia in preterm infants on admission to the neonatal intensive care unit. Int J Qual Health Care 29:1–7. https://doi.org/10.1093/intqhc/mzx131
de Siqueira Caldas JP, Ferri WAG, Marba STM, Aragon DC, Guinsburg R, de Almeida MFB, Diniz EMA, Silveira RCS, Alves Junior JMS, Pavanelli MB, Bentlin MR, Ferreira DMLM, Vale MS, Fiori HH, Duarte JLMB, Meneses JA, Cwajg S, Carvalho WB, Ferrari LSL, Silva NMM, da Silva RPGVC, Anchieta LM, Santos JPF, Kawakami MD (2019) Admission hypothermia, neonatal morbidity, and mortality: evaluation of a multicenter cohort of very low birth weight preterm infants according to relative performance of the center. Eur J Pediatr 178(7):1023–1032
Author information
Authors and Affiliations
Contributions
Dr. Deepak Sharma conceptualised and designed the study, collected data and drafted the initial manuscript. Dr. Srinivas Murki conceptualised and designed the study, critically reviewed the manuscript and, approved the final version of the manuscript. Dr. Dattatray Kulkarni helped in data collection, planning interventions and manuscript writing. Dr. Dinesh Pawale coordinated and supervised data collection and performed data analysis. Dr. Venkateshwarlu vardhelli helped in developing protocol and in data collection. Dr. Rajendra Prasad Anne helped in planning of interventions and data analysis. Dr. Tejo Pratap Oleti developed initial protocol, conceptualised and designed the study, reviewed and revised the manuscript. Dr. Saikiran Deshabhotla coordinated implementation of various interventions, supervised data collection and reviewed the manuscript for important intellectual outcome.
Corresponding author
Ethics declarations
Conflict of interest
The authors declare that they have no conflicts of interest.
Ethical approval
This article does not contain any studies with human participants or animals performed by any of the authors. Ethical approval number: 1_2018 – institutional ethics committee of Fernandez hospital, Hyderabad.
Informed consent
Research ethics committee approved the project without needing patient’s informed consent: 1_2018.
Additional information
Communicated by Daniele De Luca
Publisher’s note
Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.
Rights and permissions
About this article
Cite this article
Sharma, D., Murki, S., Kulkarni, D. et al. The impact of a quality improvement project to reduce admission hypothermia on mortality and morbidity in very low birth weight infants. Eur J Pediatr 179, 1851–1858 (2020). https://doi.org/10.1007/s00431-020-03711-7
Received:
Revised:
Accepted:
Published:
Issue Date:
DOI: https://doi.org/10.1007/s00431-020-03711-7