Pratik Pi Pragyan, Lakshminarayana Shilpa Krishnapura, Devadas Sahana, Kommalur Anitha, Sajjan Sushma Veeranna, Kariyappa Mallesh
Department of Paediatrics, Vani Vilas Hospital, Bangalore Medical College and Research Institute, Bengaluru, IND.
Cureus. 2023 Jun 12;15(6):e40301. doi: 10.7759/cureus.40301. eCollection 2023 Jun.
Background Admission hypothermia is still an underappreciated major challenge for new-born survival in low-resource settings. The WHO recommends skin-to-skin contact as the simplest and safest way for maintaining the body temperature even during transportation. Quality improvement initiatives for hospitalised new-borns have shown benefits like a reduction in neonatal morbidity and mortality. This study was undertaken in a resource-constrained public hospital in southern India with an aim to reduce neonatal hypothermia at admission to <20%. Method It was a prospective, quality improvement study undertaken over 20 weeks. All neonates born in the selected delivery room (DR), requiring transportation to the neonatal intensive care unit, were included. The primary outcome indicators were the mean axillary temperature of neonates measured upon arrival at the neonatal intensive care unit and the percentage of neonates with hypothermia at admission. Improving the thermoregulatory practices and ambient DR temperature to >25˚C, transportation by the kangaroo method, and a portable infant warmer (PIW) were implemented in three successive Plan-Do-Study-Act (PDSA) cycles. Result In the third PDSA cycle, the mean admission temperature (36.51˚C ±0.82) was significantly (p<0.0001) higher when compared with the baseline phase (35.41˚C ±1.09), and there was a significant (p<0.001) reduction in hypothermia (33.33%). The aim was achieved in the last two weeks of the third cycle with a reduction in hypothermia to 17.6%. Conclusion Implementation of appropriate thermoregulatory practices and low-cost strategies like the kangaroo method and PIW using quality improvement methodology significantly reduced admission hypothermia.
入院时体温过低仍是资源匮乏地区新生儿生存面临的一个未得到充分重视的重大挑战。世界卫生组织建议，即使在转运过程中，肌肤接触也是维持体温最简单、最安全的方法。针对住院新生儿的质量改进措施已显示出诸多益处，如降低新生儿发病率和死亡率。本研究在印度南部一家资源有限的公立医院开展，旨在将新生儿入院时体温过低的比例降至20%以下。方法：这是一项为期20周的前瞻性质量改进研究。纳入所有在选定产房出生、需要转运至新生儿重症监护病房的新生儿。主要结局指标为新生儿抵达新生儿重症监护病房时测得的平均腋温以及入院时体温过低的新生儿百分比。通过连续三个计划-实施-研究-改进（PDSA）循环，改善体温调节措施并将产房环境温度提高到>25˚C，采用袋鼠式护理法进行转运，并使用便携式婴儿暖箱（PIW）。结果：在第三个PDSA循环中，平均入院体温（36.51˚C±0.82）与基线期（35.41˚C±1.09）相比显著升高（p<0.0001），体温过低情况显著减少（p<0.001）（33.33%）。在第三个循环的最后两周实现了目标，体温过低比例降至17.6%。结论：采用质量改进方法实施适当的体温调节措施以及袋鼠式护理法和便携式婴儿暖箱等低成本策略，可显著降低入院时体温过低的情况。
