Yip Wai Yan, Quek Bin Huey, Fong Mary Choi Wan, Ong Sally Siew Gim, Lim Bee Leong, Lo Bo Chu, Agarwal Pratibha
Department of Neonatology, KK Women's and Children's Hospital, 100 Bukit Timah Road, Singapore 229899, Singapore.
Division of Nursing, KK Women's and Children's Hospital, 100 Bukit Timah Road, Singapore 229899, Singapore.
Int J Qual Health Care. 2017 Nov 1;29(7):922-928. doi: 10.1093/intqhc/mzx131.
To study effectiveness of quality improvement interventions in reducing hypothermia in preterm infants on admission to neonatal intensive care unit.
Quality improvement methodologies including multidisciplinary planning and implementation of evidence-based interventions. Data during and post-implementation were collected.
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.
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.
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.
研究质量改进干预措施在降低早产儿入住新生儿重症监护病房时体温过低发生率方面的有效性。
采用包括多学科规划和实施循证干预措施在内的质量改进方法。收集实施期间及实施后的相关数据。
将实施期间（2008年10月至2009年4月）出生体重≤1500g的84例早产儿与168例历史对照以及随后4年中的947例婴儿进行比较。
除常规干预措施外，提高产房温度，并在初始稳定期使用全身聚乙烯包裹物和羊毛帽。提供教育和培训以强化新的干预措施。
主要结局为体温过低发生率和平均入院体温。次要结局为脑室内出血发生率和死亡率。
入院时体温过低发生率从79.4%降至40.5%（P<0.001），改善了49%（OR=0.177，95%CI：0.099-0.316）。平均入院体温从35.8±0.8°C升至36.5±0.7°C（P<0.001）。体温过高发生率为6%，高于基线的1.3%（P=0.049）。实施后的4年中，入院时体温过低发生率稳定在47.4%。脑室内出血发生率和死亡率保持不变。小于胎龄儿、5分钟阿氏评分低和单胎分娩是与入院时体温过低相关的因素。
实施循证最佳实践显著降低了早产儿入院时体温过低的发生率，且在实施后持续了4年。此后，这些实践已成为我们机构的护理标准。
