Department of Pediatrics/Neonatology, Albany Medical Center MC-101, 47 New Scotland Ave., Albany, NY 12208.
Pediatrics. 2014 Jan;133(1):e218-26. doi: 10.1542/peds.2013-1293. Epub 2013 Dec 16.
Hypothermia during delivery room stabilization of very low birth weight (VLBW) newborns is independently associated with mortality, yet it occurred frequently both in collaborative networks and at our institution. We aimed to attain admission temperatures in the target range of 36 °C to 38 °C in ≥ 90% of inborn VLBW neonates through implementation of a thermoregulation bundle.
This quality improvement project extended over 60 consecutive months, using sequential plan-do-check-act cycles. During the 14 baseline months, we standardized temperature measurements and developed the Operation Toasty Tot thermoregulation bundle (including consistent head and torso wrapping with plastic, warmed blankets, and a closed stabilization room). We introduced this bundle in month 15 and added servo-controlled, battery-powered radiant warmers for stabilization and transfer in month 21. We provided results and feedback to staff throughout, using simple graphics and control charts.
There were 164 inborn VLBW babies before and 477 after bundle implementation. Introduction and optimization of the bundle decreased the incidence of hypothermia, with rates remaining in the target range for the last 13 study months. The incidence of temperatures >38 °C was ~ 2% both before and after bundle implementation.
This thermoregulation bundle resulted in sustained improvement in normothermia rates during delivery room stabilization of VLBW newborns. Our benchmark goal of ≥ 90% admission temperatures above 36 °C was met without increasing hyperthermia rates. Because these results compare favorably with those of recently published research or improvement collaboratives, we aim to maintain our performance through routine surveillance of admission temperatures.
极低出生体重儿（VLBW）在产房稳定期的低体温与死亡率独立相关，但在合作网络和我们机构中，这种情况经常发生。我们的目标是通过实施体温调节套件，使 90%以上的内生 VLBW 新生儿的入院温度达到 36°C 至 38°C 的目标范围。
该质量改进项目持续了 60 个月，采用了连续的计划-执行-检查-行动循环。在 14 个基线月期间，我们标准化了体温测量，并开发了“Operation Toasty Tot”体温调节套件（包括用塑料、加热毯子和封闭的稳定室对头部和躯干进行一致的包裹）。我们在第 15 个月引入了该套件，并在第 21 个月增加了伺服控制、电池供电的辐射加热器，用于稳定和转移。我们通过简单的图形和控制图向员工提供结果和反馈。
在实施套件之前有 164 名内生 VLBW 婴儿，之后有 477 名。套件的引入和优化降低了低体温的发生率，在最后 13 个研究月中，温度仍保持在目标范围内。在实施套件前后，体温>38°C 的发生率约为 2%。
该体温调节套件使 VLBW 新生儿在产房稳定期间的正常体温率持续得到改善。我们设定的≥90%入院温度高于 36°C 的基准目标得到了实现，而没有增加高热的发生率。由于这些结果与最近发表的研究或改进合作的结果相媲美，我们计划通过常规监测入院温度来维持我们的表现。
