Achieving Normothermia in Low-Birth-Weight Neonates

Abstract

Achieving normothermia, defined as an axillary temperature of 36.5°C–37.5°C, in very-low-birth-weight (LBW) neonates (<1,500 g and/or <32 weeks gestational age), has been shown to improve patient outcomes and decrease morbidities and mortality. Reduce by 10% hypothermia (temperatures <36.5oC) on NICU admission for all neonates weighing less than 1,500 g at birth and/or births that are less than 32 weeks gestation. Research has shown an association between hypothermic admission temperatures and increased mortality and morbidity in preterm newborns. Evidence shows that for every decrease of 1°C in admission temperature below 36.5°C, there is an 11% increase in the odds of developing late-onset sepsis and 28% increase in the odds of death. In October 2017, a multidisciplinary team reviewed existing internal data reports and data from the California Perinatal Quality Care Collaborative (CPQCC) regarding neonatal hypothermia admission rates. The plan, do, act, study methodology was used for this quality improvement project. All practice changes were reviewed and discussed at monthly interdisciplinary meetings. The goal was set for ambient temperatures in the delivery rooms and operating rooms to be set at 72°F or higher. Using the Textbook of Neonatal Resuscitation (7th ed.) thermoregulation guidelines, a “small baby” kit was created with warming items to be used in the delivery rooms. Before leaving the delivery room, a minimum goal for the neonate’s axillary temperature was set at 36.8°C. If the neonate’s temperature was less than 36.8°C, thermoregulation interventions were performed by the neonatal team until the target temperature was reached. Information was disseminated to all staff on the labor and delivery (L&D) and NICU units regarding the performance-improvement goals. Quarterly data reports were posted on both units reflecting the data. From 2016 to 2018, newborn normothermia rates at our facilities increased from 70% to 85%, and hypothermia rates decreased from 26.5% to 2.8%. A multidisciplinary team approach between L&D and NICU units was crucial in achieving our goal and improving the care for our smallest patients.