213 - Minimizing Hypothermia in the First 24 hours of Life in a Delivery Unit

Monday, May 1, 2023

9:30 AM – 11:30 AM ET

Poster Number: 213
Publication Number: 213.44

Amy L. Lembeck, Childrens Hospital of Philadelphia, Newtown Square, PA, United States; Melissa A. Hewitt, Jefferson Health, Hatfield, PA, United States

Presenting Author(s)

Amy L. Lembeck, DO (she/her/hers)

Neonatologist
Childrens Hospital of Philadelphia
Newtown Square, Pennsylvania, United States

Background: Hypothermia following delivery is a common modifiable problem among all infants both term and preterm. Cold stress contributes to morbidity following delivery potentially resulting in admission to the NICU or prolonged length of stay.

Objective: In conjunction with a late preterm quality improvement project, our Delivery unit sought to decrease late-preterm (35 0/7 weeks to 36 6/7 weeks) and term (37 0/7 and greater) hypothermia in the first 24 hours by using The Model for Improvement.

Design/Methods: Baseline data were collected at our 1900 delivery level 3 NICU community hospital in Pennsylvania. Using multiple PDSA cycles, the team measured number of cold (< 36.5 degrees Celsius) infants in the first 24 hours of life to determine effect of change. Interventions aimed at education and modifying environment to improve euthermia. Several interventions, while specifically directed towards late preterm infants were also instituted in our term infant population. Nursing driven education directed at radiant warmer management in the delivery room, swaddling and management post-delivery, and for transport as well as standardization of equipment were some of the modifications made. We evaluated outcomes via statistical process control measures. Our balancing measure included monitoring for hyperthermia (≥38 degrees Celsius) in the first 24 hours.

Results: Data were collected over a 2 year period. Interventions occurred over 18 months and included standardization of equipment and procedure as well as enhanced education and focus. Following several PDSA cycles, our control chart reached significance with a special cause signal shift with our new center line of 6% down from 21% infants per month. Hyperthermia rates remained low but occurred most frequently within the first 2 hours of life. Birth rates remained consistent over time.

Conclusion(s):

By education and focus on euthermia via interventions including modifications in blankets, nursing education on radiant warmers and post-delivery management in Labor and Delivery and improved post-partum bundling, our infants have shown improvement in euthermia in the first 24 hours across gestational ages. These changes occurred without increasing the number of hyperthermic infants.