Quality improvement effort to reduce hypothermia among high-risk infants on a mother-infant unit.

Abstract

Commentary on: Andrews C, Whatley C, Smith M, et al. Quality-Improvement Effort to Reduce Hypothermia Among High-Risk Infants on a Mother-Infant Unit. Pediatrics. 2018;141(3):e20171214 Hypothermia, especially in low birthweight (LBW) and late preterm infants (LPIs), is associated with neonatal mortality and morbidity 1, 2. This quality improvement study investigated the use of multiple thermoregulation interventions to prevent hypothermia in this population. Previous clinical trials have shown evidence for the use of multiple combined thermoregulation interventions compared to individual interventions in isolation 3, 4. In this study, several thermoregulatation strategies were implemented, including of a plastic-lined knit hat, delaying baths until at least 12 hours of age, conducting all assessments in the first 12 hours of life under a radiant warmer and the clear identification of at risk infants. It showed that these strategies decreased the hypothermic rates in LBW and LPIs sequentially over the three PDSA cycles. These results strength the evidence base that multiple thermoregulation interventions are superior to single intervention approaches in the prevention of neonatal hypothermia. This study is of importance as LBW and LPIs are an understudied group, in particular in the area of quality improvement activities. Most studies to date surrounding the prevention of hypothermia have been restricted to neonatal intensive care units 3. This study is, however, limited in its generalisability, as the study was performed in a small hospital nursery unit where the strategies were easily communicated amongst the relatively small numbers of staff. This may be more difficult to implement in larger institutions where there is a greater turnover of nursery staff. The study did not take into account seasonal variations, which may have had an effect in the environmental temperatures affecting the rates of hypothermia, as well as other potential unmeasured differences. The study did not report timing of temperature measurements, numbers of times per day temperatures were routinely measured and the environment in which the infant was in when identified as hypothermic e.g., during kangaroo care or in a cold room. Collection of data around medical interventions precipitated by the diagnosis of hypothermia would have strengthened the study. There were also a number of benefits identified in this study. The results from the third PDSA cycle, implementing several thermoregulations strategies in combination, significantly decreased the rates of hypothermia in the study population subgroup (LBWs and LPIs). The implementation of these simple, low-cost strategies had a clinically meaningful decrease in hypothermic rates. In other highly resourced settings, these approaches may have a similar effects on hypothermia rates in LBW and LPIs. This has the potential to decrease further medical complications in this group, e.g., hypoglycaemia, decrease the likelihood of maternal–infant separation, and reduce healthcare costs. Further large, multi-centre trials are warrented in the area of thermoregulation strategies in the population of LBW and LPIs. This could go on to further develop universal strategies to be implemented throughout mother–infant nurseries to significantly reduce hypothermic rates in newborn infants, thereby decreasing morbidity and reducing healthcare costs. https://ebneo.org/2018/06/quality-improvement-effort-to-reduce-hypothermia-among-high-risk-infants-on-a-mother-infant-unit/ None. None.