A quality improvement project to reduce hypothermia in preterm infants on admission to the neonatal intensive care unit

Wai Yan Yip, Bin Huey Quek, Mary Choi Wan Fong, Thilagamangai, Sally Siew Gim Ong, Bee Leong Lim, Bo Chu Lo, Pratibha Agarwal
International Journal for Quality in Health Care 2017 November 1, 29 (7): 922-928

Objective: To study effectiveness of quality improvement interventions in reducing hypothermia in preterm infants on admission to neonatal intensive care unit.

Design: Quality improvement methodologies including multidisciplinary planning and implementation of evidence-based interventions. Data during and post-implementation were collected.

Setting and participants: In total, 84 preterm infants with birth weights ≤ 1500 g delivered during implementation period (October 2008-April 2009) were compared with 168 historical controls and 947 infants in the subsequent 4 years.

Intervention(s): In addition to routine interventions, delivery room temperatures were increased, and use of full-body polyethylene wraps and woollen caps were implemented during initial stabilization. Education and training were provided to reinforce the new interventions.

Main Outcome Measure(s): Primary outcome was incidence of hypothermia and mean admission temperature. Secondary outcomes were rates of intraventricular haemorrhage and mortality.

Results: Incidence of admission hypothermia decreased from 79.4 to 40.5% (P < 0.001), constituting a 49% improvement (OR = 0.177, 95% CI: 0.099-0.316). Mean admission temperature increased from 35.8 ± 0.8°C to 36.5 ± 0.7°C (P < 0.001). Hyperthermia incidence was higher at 6% compared to baseline of 1.3% (P = 0.049). The incidence of admission hypothermia remained stable at 47.4% in the 4 years post-implementation. Rates of intraventricular haemorrhage and mortality remained unchanged. Small for gestation, low 5-min Apgar score and singleton delivery were factors found to be associated with admission hypothermia.

Conclusion: The implementation of evidence-based best practices resulted in significant reduction in admission hypothermia in preterm infants, which persisted for 4 years post-implementation. The practices have since become standard of care in our institution.

Full Text Links

Find Full Text Links for this Article


You are not logged in. Sign Up or Log In to join the discussion.

Related Papers

Remove bar
Read by QxMD icon Read

Save your favorite articles in one place with a free QxMD account.


Search Tips

Use Boolean operators: AND/OR

diabetic AND foot
diabetes OR diabetic

Exclude a word using the 'minus' sign

Virchow -triad

Use Parentheses

water AND (cup OR glass)

Add an asterisk (*) at end of a word to include word stems

Neuro* will search for Neurology, Neuroscientist, Neurological, and so on

Use quotes to search for an exact phrase

"primary prevention of cancer"
(heart or cardiac or cardio*) AND arrest -"American Heart Association"