Neonatal Med.  2024 May;31(2):38-46. 10.5385/nm.2024.31.2.38.

Quality Improvement Project to Reduce Admission Hypothermia of Preterm Infants Born at Less than 32 Weeks or 1,500 g

• Kim H
• Hwang J
• Kim C
• Kim SH
• Yang M
• Ahn SY
• Sung SI
• Chang YS

• KMID: 2556153
• DOI: http://doi.org/10.5385/nm.2024.31.2.38

Abstract

Purpose
Hypothermia upon admission to the neonatal intensive care unit (NICU) contributes significantly to various neonatal complications, particularly in preterm infants. This study aimed to assess the impact of quality improvement (QI) interventions, including using plastic bags and head caps, and adjusting delivery room temperatures, on improving the admission body temperature and reducing hypothermia in infants born at less than 32 weeks or weighing 1,500 g.
Methods
This study retrospectively analyzed the medical records of infants born at less than 32 weeks or weighing 1,500 g who admitted to the NICU at Samsung Medical Center from January 2022 to February 2024. The QI program that was initiated in April 2023 focused on managing admission temperatures using plastic bags and head caps, and maintaining delivery room temperatures at ≥25 °C. The admission temperature and short-term outcomes pre- and post-QI were compared.
Results
In a study of 270 patients, implementing QI initiatives significantly raised the admission temperature from 36.2±0.5 to 36.4±0.4 °C (p<0.01), particularly impacting infants weighing ≥1,000 g, in whom mild hypothermia occurrences dropped from 76.3% to 43.9% (p<0.01). This improvement in temperature management significantly decreased both mild and severe hypothermia rates post-QI. Additionally, implementing all three initiatives was more effective than when two or fewer initiatives were implemented.
Conclusion
Simple and cost-effective QI interventions can increase admission temperatures and decrease hypothermia in neonates. Further research is essential to explore the long-term outcomes and develop effective hypothermia management strategies in neonatal care.

Keyword

Body temperature; Hypothermia; Premature; Quality improvement

Figure

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  Figure 1. Flowchart of the study design for patient enrollment. Abbreviations: VLBWI, very low birth weight infant; SMC, Samsung Medical Center; QI, quality improvement.

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  Figure 2. Statistical process control chart for initial body temperature: pre-quality improvement (QI) vs. post-QI.

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  Figure 3. Implementing quality improvement (QI) interventions. Abbreviation: DR, delivery room.

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