The problem identified for this quality improvement (QI) initiative was admission hypothermia in low birth-weight neonates. The setting was a 32-bed level IV neonatal intensive care unit (NICU) in a freestanding not-for-profit Magnet-designated pediatric medical center in the Northeastern United States. In 2016, the NICU QI team implemented a thermoregulation bundle for extremely low birthweight (<1000 g) and very low birth-weight (VLBW) (<1500 g) neonates that significantly improved hypothermia in these populations, especially in neonates born less than 1000 g. 1 Despite these improvements, data revealed that of the neonates who remained hypothermic at NICU admission during this time, the majority (85%) weighed between 1000 and 1500 g. The intervention at that time varied for neonates born less than 1000 g compared with those between 1000 and 1500 g. In addition, the Neonatal Resuscitation Program (NRP) had recently recommended revised thermoregulation interventions for all newborns born at less than 32 weeks (regardless of birth weight). 2 The purpose of this QI project was to initiate a revised thermoregulation support bundle in all neonates admitted to the NICU less than 32 weeks or less than 1500 g at birth to reduce admission hypothermia.
BACKGROUND/AVAILABLE KNOWLEDGEThermoregulation, often described as the cornerstone of neonatal care, 3 can be one of the most challenging aspects of admission care for preterm newborns. 4 After birth, neonates quickly lose heat due to exposure via conduction, convection, radiation, and evaporation. This leads to hypothermia if effective thermoregulation supports are not in place. 5 Despite advances in thermoregulation equipment and awareness of health implications, globally and in the
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