Hypothermia after birth is associated with mortality and morbidity in preterm neonates. We examined the effect of a bundled intervention set on the incidence of hypothermia at time of neonatal intensive care unit (NICU) admission in preterm neonates born at Stamford Hospital.
In Fall 2012, an intervention bundle for preterm neonates was developed, including 1) maintenance of operating and delivery room ambient temperature at 25°C; 2) maintenance of transport incubator temperature at 36°C; 3) increase radiant warmer temperature to maximum; 4) cover the neonate with a prewarmed towel during delayed cord clamping; 5) use prewarmed blankets or towels to dry preterm neonates; 6) use of exothermic mattress for resuscitation; 7) use of prewarmed polyethylene wraps for neonates born before 28 completed weeks of gestation; 8) monitoring of neonate temperatures during resuscitation, maintain temperature greater than 35.9°C before transportation to the NICU; and 9) defer weight assessment until admission at Stamford Hospital, infants born before 36 weeks of gestation are admitted to the NICU. Rectal temperature is measured on admission routinely. Hypothermia was defined as core body temperature less than 36.5°C. Neonatal intensive care unit admission temperatures for all preterm births were tracked during August to December, 2012. The intervention bundle was implemented in January 2013. Tracking of temperatures was continued through September 2013. Hypothermia rates were compared before and after implementation using χ2 test.
Of 45 preterm neonates born before implementation, 35 demonstrated hypothermia on admission. After implementation of this protocol, 115 preterm neonates were delivered; 40 demonstrated hypothermia. This reduction in hypothermia was statistically significant (P<.001).
A bundled neonate warming intervention significantly decreased the incidence of neonatal hypothermia in preterm neonates born at Stamford Hospital.