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

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.