Department of Neonatology, Neoclinic Children Hospital, Jaipur, Rajasthan, India.
J Neonatal Perinatal Med. 2021;14(2):277-286. doi: 10.3233/NPM-190385.
Hypothermia at admission to neonatal intensive care units (NICU) is associated with increased morbidity and mortality in newborns. A baseline study at a tertiary care hospital with all out-born babies showed admission hypothermia of 82%.
To reduce admission hypothermia (moderate) in newborns at least by 50% in next 6 months.
A quality improvement (QI) study was planned using WHO Point of Care Quality Improvement Model (POCQI), [17] using PDSA (Plan-Do-Study-Act) cycle approach from April 2018 to March 2019, and including 427 term and preterm babies. We educated the staff, reinforced the use of caps, cling wraps, warm linen, introduced Ziploc bags and ensured adequate use of transport incubator.
After 6 months, overall admission hypothermia decreased from 82% to 45%, moderate hypothermia reduced from 46% to <10% (P < 0.001) and severe hypothermia (3%) was completely eliminated. There was also significant reduction in incidence of Intraventricular hemorrhage (13% Vs 4.7%), Late onset neonatal sepsis (38% Vs 19%) and metabolic acidosis (43% Vs 28%). We were able to sustain this improvement for the next 6 months and is ongoing. The strongest predictor of hypothermia was newborns being in the phase before QI initiative was started (OR 2.36, 95% CI 1.47, 3.23).
This study is a cost effective approach in reducing admission hypothermia in NICU in a resource limited setting with all outborn babies, and further decreasing the morbidity associated with it. Hence, emphasizing the importance of maintaining euthermia, not only in delivery rooms, but also during transportation.
新生儿重症监护病房（NICU）入院时体温过低与新生儿发病率和死亡率增加有关。在一家三级保健医院对所有出生儿进行的基线研究显示，入院时体温过低的比例为 82%。
在接下来的 6 个月内，将新生儿入院时体温过低（中度）至少降低 50%。
使用世界卫生组织即时护理质量改进模型（POCQI）[17]，采用计划-实施-研究-行动（PDSA）循环方法，于 2018 年 4 月至 2019 年 3 月进行了一项质量改进（QI）研究，共纳入 427 例足月和早产婴儿。我们对工作人员进行了教育，加强了帽子、保鲜膜、温暖的亚麻布的使用，引入了拉链袋，并确保充分使用运输保温箱。
6 个月后，总体入院体温过低从 82%降至 45%，中度体温过低从 46%降至<10%（P<0.001），严重体温过低（3%）完全消除。颅内出血（13%比 4.7%）、晚发性新生儿败血症（38%比 19%）和代谢性酸中毒（43%比 28%）的发生率也显著降低。我们能够在接下来的 6 个月内维持这种改善，并正在继续进行。体温过低的最强预测因素是新生儿在 QI 计划启动前的阶段（OR 2.36，95%CI 1.47，3.23）。
在资源有限的情况下，对所有出生儿进行这项研究是一种降低 NICU 入院时体温过低的具有成本效益的方法，并进一步降低了与之相关的发病率。因此，强调了在分娩室以及在运输过程中保持体温正常的重要性。
