Decreasing Hypothermia-Related Escalation of Care in Newborn Infants Using the BEMPU TempWatch: A Randomised Controlled Trial.

Donna Lei,Kenneth Tan,Atul Malhotra

doi:10.3390/children8111068

Abstract

Objective: To determine whether incorporating BEMPU TempWatch into the care of LBW/SGA neonates for continuous temperature monitoring decreases the rate of hypothermia requiring escalation of care. Methods: This was a randomised controlled trial conducted in a tertiary hospital in Melbourne, Australia. Participants were late preterm and term LBW/SGA neonates on the postnatal wards. Neonates were randomly assigned to receive either the BEMPU TempWatch in addition to standard care, or to receive standard care alone for the first 28 days of life. The primary outcome was hypothermia requiring escalation of care during initial hospital stay after birth. Results: Trial was discontinued after planned interim feasibility analysis, due to very low rates of hypothermia requiring escalation of care. In total, 75 neonates were included, with 36 in the intervention (TempWatch) group and 39 in the control group. The rate of hypothermia requiring escalation of care was 2/36 (5.6%) in the TempWatch group and 1/39 (2.6%) in the control group (relative risk (RR) 2.17, 95% CI 0.21 to 22.89). Rates of exclusive breastfeeding at discharge were 22/36 (61.1%) in the TempWatch and 13/39 (33.3%) in the control group (RR 1.83, 95% CI 1.10 to 3.07, p = 0.02). All other secondary outcomes were similar between the groups. Conclusions: Low rates of hypothermia requiring escalation of care in a tertiary, high-income setting meant it was not feasible for studying the effects of the TempWatch for this outcome. TempWatch may have a role in promoting exclusive breastfeeding, and this needs to be explored further.

Highlights

Low birth weight (LBW) and small for gestational age (SGA) babies are at a greater risk of hypothermia due to numerous factors that either increase their heat loss [1] or reduce their ability to produce heat to maintain normothermia [2] compared with normal birth weight and appropriate for gestational age neonates
69 neonates were admitted to the special care nursery (SCN) or neonatal intensive care unit (NICU) soon after birth and were not returned to the postnatal wards within 48 h after delivery
One family in the TempWatch group was unable to be contacted for the follow-up phone call

Summary

Introduction

Low birth weight (LBW) and small for gestational age (SGA) babies are at a greater risk of hypothermia due to numerous factors that either increase their heat loss [1] or reduce their ability to produce heat to maintain normothermia [2] compared with normal birth weight and appropriate for gestational age neonates. Detection of hypothermia allows for prompt intervention with conservative warming measures and may reduce the need for invasive warming measures, including placement on a heated mattress, under a radiant warmer, or in an incubator. These measures are costly [3], pose risks to the baby including overheating [4] and dehydration [5], and separate babies from their mothers [6]. Many methods of temperature monitoring in neonates are available [7]. Many of these have variable accuracy, suboptimal efficacy, and are unable to continuously monitor the neonate

Results

Discussion

Conclusion