Cleator Alexander James, Coombe Emma, Alexopoulou Vasiliki, Levingston Laura, Evans Kathryn, Hurst Jonathan Christopher, Yoxall Charles William
Liverpool Women's Hospital, Liverpool L8 7SS, UK.
Children (Basel). 2022 Jan 5;9(1):75. doi: 10.3390/children9010075.
We had experienced an increase in admission hypothermia rates during implementation of deferred cord clamping (DCC) in our unit. Our objective was to reduce the number of babies with a gestation below 32 weeks who are hypothermic on admission, whilst practising DCC and providing delivery room cuddles (DRC).
A 12 month quality improvement project set, in a large Neonatal Intensive Care Unit, from January 2020 to December 2020. Monthly rates of admission hypothermia (<36.5 °C) for all eligible babies, were tracked prospectively. Each hypothermic baby was reviewed as part of a series of Plan, Do, Study Act (PDSA) cycles, to understand potential reasons and to develop solutions. Implementation of these solutions included the dissemination of the learning through a variety of methods. The main outcome measure was the proportion of babies who were hypothermic (<36.5 °C) on admission compared to the previous 12 months.
130 babies with a gestation below 32 weeks were admitted during the study period. 90 babies (69.2%) had DCC and 79 babies (60%) received DRC. Compared to the preceding 12 months, the rate of hypothermia decreased from 25/109 (22.3%) to 13/130 (10%) ( = 0.017). Only 1 baby (0.8%) was admitted with a temperature below 36 °C and 12 babies (9.2%) were admitted with a temperature between 36 °C and 36.4 °C. Continued monitoring during the 3 months after the end of the project showed that the improvements were sustained with 0 cases of hypothermia in 33 consecutive admissions.
It is possible to achieve low rates of admission hypothermia in preterm babies whilst providing DCC and DRC. Using a quality improvement approach with PDSA cycles is an effective method of changing clinical practice to improve outcomes.
在我们科室实施延迟脐带结扎（DCC）期间，入院时体温过低的发生率有所上升。我们的目标是减少孕周低于32周的婴儿入院时体温过低的数量，同时实施DCC并提供产房肌肤接触（DRC）。
在一家大型新生儿重症监护病房开展了一项为期12个月的质量改进项目，时间为2020年1月至2020年12月。对所有符合条件的婴儿每月入院时体温过低（<36.5°C）的发生率进行前瞻性跟踪。作为一系列计划、执行、研究、改进（PDSA）循环的一部分，对每个体温过低的婴儿进行评估，以了解潜在原因并制定解决方案。这些解决方案的实施包括通过多种方法传播经验教训。主要结局指标是与前12个月相比，入院时体温过低（<36.5°C）的婴儿比例。
研究期间共收治了130例孕周低于32周的婴儿。90例（69.2%）接受了DCC，79例（60%）接受了DRC。与前12个月相比，体温过低的发生率从25/109（22.3%）降至13/130（10%）（P = 0.017）。只有1例婴儿（0.8%）入院时体温低于36°C，12例婴儿（9.2%）入院时体温在36°C至36.4°C之间。项目结束后的3个月内持续监测显示，改进效果得以维持，连续33例入院病例中无体温过低情况。
在提供DCC和DRC的同时，有可能使早产儿入院时体温过低的发生率保持在较低水平。采用PDSA循环的质量改进方法是改变临床实践以改善结局的有效方法。
