214 - Reducing Hypothermia in preterm infants < 36 weeks gestational age (GA) admitted to NICU at Maimonides Children’s Hospital

Poster Number: 214
Publication Number: 214.126

neelam pandhi, Maimonides Infants and Children's Hospital of Brooklyn, lynbrook, NY, United States; Mehbeen Khan, Maimonides Infants and Children's Hospital of Brooklyn, Brooklyn, NY, United States

Background: Hypothermia at admission is associated with increased adverse events such as respiratory distress, apnea, hypoglycemia acidosis and increased mortality, especially in preterm infants. Preterm infants have a higher risk of hypothermia due to their immature regulation system, decreased fat and glycogen stores, lower muscle mass and tone, poor vascular control, a lower maximal metabolism, and a narrower range of thermal control.
Interventions to reduce heat loss in preterm infants have been extensively studied. Most studies have included multidisciplinary approaches involving numerous personnel to maintain thermoregulation. In resource-limited settings this is not practical or sustainable.

Thermoregulation QIs can positively impact the admission temperatures of premature/very-low-birth-weight infants in the NICU. Prevention of hypothermia is aimed at reducing the risks of developing major neonatal morbidities.

Objective: Our SMART AIM will be to improve NICU admission temperatures to normal range between 36.5 C -37.5 C for infants < 36 weeks GA to 80% (from the baseline of 39%) in a one year timeframe by implementing a plan-study-act-do (PDSA) methodology.

Design/Methods: Retrospective chart review from July 2019 to June 2020 established a baseline incidence of hypothermia (temperature ≤36.50C) of 61% in infants < 36 weeks GA admitted to the Maimonides Medical Center NICU.

This quality intervention study is a prospective project that will aim to achieve 80% of admission temperature between 36.50C -37.50C for preterm infants < 36 weeks GA by implementing a plan-study-act-do (PDSA) methodology focusing on a thermoregulation bundle, including a thermal hat and plastic bag. Admission temperature will be defined as the first documented temperature in the medical records. The study will take place in the NICU and DR/OR at Maimonides Medical Center.

PDSA Cycle 1 - NICU Team education
PDSA Cycle 2 - Thermoregulation bundle with thermal hat and plastic wrap
PDSA Cycle 3 - Implemented Golden Hour Admission Tool - Currently in data collection for PDSA Cycle 3

Results: A total of 564 infants were included in the study.
Incidence of hypothermia on admission
60% - baseline,
67% - PDSA cycle 1,
18% - PDSA cycle 2,
PDSA cycle 3 - data collection (will have results by PAS conference)
There was a statistically significant reduction in hypothermia after the thermoregulation bundle was introduced with a p value < 0.0001.Conclusion(s): Our study proves that it is feasible to achieve and sustain optimal admission temperature in preterm infants using minimal resources in a resource limited, inner city NICU.
RESUMEPandhi, Neelam_CV_1.2022.pdf
Fishbone Diagram/ Root Cause Analysis