Association of Rewarming Rate on Neonatal Outcomes in Extremely Low Birth Weight Infants with Hypothermia

Morassutti, Francesca Rech; Cavallin, Francesco; Zaramella, Patrizia; Bortolus, Renata; Parotto, Matteo; Trevisanuto, Daniele

doi:10.1016/j.jpeds.2015.06.008

Cited by 18 publications

(11 citation statements)

References 25 publications

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“…Guidelines for the rate of rewarming the hypothermic VLBW/ELBW are lacking. 26 Gradual rewarming by 0.5C°/h was used throughout all periods as it is currently recommended for patients with both intended and unintended hypothermia to avoid complications such as shock, seizures, and arrhythmias. 27–29 Thus, we chose a threshold of <20% incidence of admission hypothermia for the primary outcome measure to account for a potentially irreducible number of patients that would not achieve normothermia (if originally hypothermic) due to short transport times.…”

Section: Discussionmentioning

confidence: 99%

“…27–29 A faster rewarming rate (>0.5°C/h) has been suggested to have no increased risk in poor neonatal outcomes and may actually decrease the incidence of respiratory distress syndrome in the ELBW population. 26 Such a change may ameliorate the increased risk for morbidity and mortality that VLBW/ELBW neonates requiring interfacility transport have compared with their inborn cohorts.…”

Section: Discussionmentioning

confidence: 99%

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Improving Thermal Support in Very and Extremely Low Birth Weight Infants during Interfacility Transport

McNellis

Leonard

Thornton

et al. 2019

Pediatric Quality &Amp; Safety

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Introduction: Review of very low birth weight (VLBW) and extremely low birth weight (ELBW) neonates transported by our specialized pediatric/neonatal transport team revealed hypothermia in up to 52% of admissions. This project aimed to decrease the incidence of hypothermia in VLBW and ELBW neonates requiring transport between facilities from 52% to <20% over 1 year. Methods: In response to gaps in knowledge and barriers to care revealed by a survey administered to transport personnel, we used a standard quality improvement plan-do-study-act model to introduce new equipment and a comprehensive thermoregulation protocol via standardized education. The primary outcome measure was the incidence of hypothermia (axillary temperature < 36.5°C) in transported VLBW and ELBW neonates. The process measure was compliance with the protocol. The balancing measures were unintended hyperthermia and transport team ground time. Transport personnel were updated on progress via meetings and run charts. Results: We reduced the incidence of hypothermia to 17% in 1 year. Compliance with the protocol improved from 60% to 76%. There was no increase in unintended hyperthermia (5% preintervention, 4% intervention, 7% surveillance, P = 0.76) or transport team ground time (in hours) (1.2 ± 0.9 preintervention versus 1.3 ± 0.8 intervention versus 1.2 ± 0.7 surveillance, P = 0.2). Conclusions: Quality improvement methods were used to develop an evidence-based, standardized approach to thermal support in VLBW and ELBW neonates undergoing transport between facilities. Following the implementation of this approach, we achieved the desired percent decrease in the incidence of hypothermia.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Improving Thermal Support in Very and Extremely Low Birth Weight Infants during Interfacility Transport

McNellis

Leonard

Thornton

et al. 2019

Pediatric Quality &Amp; Safety

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“…An EvUp (see Supplement Appendix C-10) identified 133 studies; of these, 2 were considered eligible for inclusion. Although the EvUp identified no new prospective trials of rates of rewarming, the 2 new retrospective studies 124,125 increased the number of infants in observational trials nearly 4-fold to 379 infants. Both studies found that the rate of rewarming (after adjustment for confounders) was not associated with the critical outcomes identified in each study.…”

Section: Rewarming Of Hypothermic Newborns (Nls 858: Evup)mentioning

confidence: 99%

Neonatal Life Support 2020 International Consensus on Cardiopulmonary Resuscitation and Emergency Cardiovascular Care Science With Treatment Recommendations

Wyckoff¹,

Wyllie²,

Aziz³

et al. 2020

Resuscitation

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114

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This 2020 International Consensus on Cardiopulmonary Resuscitation and Emergency Cardiovascular Care Science With TreatmentRecommendations (CoSTR) for neonatal life support includes evidence from 7 systematic reviews, 3 scoping reviews, and 12 evidence updates.The Neonatal Life Support Task Force generally determined by consensus the type of evidence evaluation to perform; the topics for the evidence updates followed consultation with International Liaison Committee on Resuscitation member resuscitation councils. The 2020 CoSTRs for neonatal life support are published either as new statements or, if appropriate, reiterations of existing statements when the task force found they remained valid.Evidence review topics of particular interest include the use of suction in the presence of both clear and meconium-stained amniotic fluid, sustained inflations for initiation of positive-pressure ventilation, initial oxygen concentrations for initiation of resuscitation in both preterm and term infants, use of epinephrine (adrenaline) when ventilation and compressions fail to stabilize the newborn infant, appropriate routes of drug delivery during resuscitation, and consideration of when it is appropriate to redirect resuscitation efforts after significant efforts have failed.All sections of the Neonatal Resuscitation Algorithm are addressed, from preparation through to postresuscitation care. This document now forms the basis for ongoing evidence evaluation and reevaluation, which will be triggered as further evidence is published.Over 140 million babies are born annually worldwide (https://ourworldindata.org/grapher/births-and-deaths-projected-to-2100). If up to 5% receive positive-pressure ventilation, this evidence evaluation is relevant to more than 7 million newborn infants every year. However, in terms of early care of the newborn infant, some of the topics addressed are relevant to every single baby born.

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“…Ein aktueller ILCOR-Evidenzreview konnte zeigen, dass seit den vorherigen Leitlinien keine zusätzlichen systematischen Reviews oder RCT veröffentlicht wurden [ 1 ]. Zwei retrospektive Beobachtungsstudien mit 182 Patienten [ 341 ] und 98 Patienten [ 342 ] wurden identifiziert, die untersuchten, ob eine schnelle oder langsame Wiedererwärmung bei Neugeborenen mit Hypothermie (≤ 36 °C bei Aufnahme) das Outcome verändert. Nach Elimination von Störfaktoren zeigten die Ergebnisse beider Studien, dass die kritischen und relevanten Outcomeparameter durch die Geschwindigkeit der Wiedererwärmung nicht beeinflusst werden.…”

Section: Wissenschaftliche Grundlagen Auf Deren Basis Die Empfehlungen Für Die Praxis Zur Versorgung Und Reanimation Des Neugeborenen Berunclassified

Versorgung und Reanimation des Neugeborenen nach der Geburt

Madar

Roehr

Ainsworth³

et al. 2021

Notfall Rettungsmed

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Die vorliegenden Leitlinien des European Resuscitation Council zur Versorgung und Reanimation des Neugeborenen nach der Geburt beruhen auf dem International Liaison Committee on Resuscitation (ILCOR) 2020 Consensus on Science and Treatment Recommendations (CoSTR) for Neonatal Life Support (NLS). Sie beinhalten Empfehlungen zur Versorgung und Reanimation des reifen Neugeborenen und zur Stabilisierung des Frühgeborenen. Sie umfassen den aktualisierten Algorithmus zur Reanimation des Neugeborenen, die Vorbereitungen vor der Versorgung eines Neugeborenen, die Themen Training und Ausbildung, Wärmemanagement, Empfehlungen zum Abnabeln, die initiale Beurteilung und Einschätzung des Neugeborenen, das Atemwegsmanagement, inklusive einer Notfallbeatmung, und die Kreislaufunterstützung im Falle einer vollen Reanimation. Darüber hinaus finden sich Empfehlungen zur Kommunikation mit den Eltern und ethische Überlegungen, in welchen Situationen erwogen werden soll, auf Reanimationsmaßnahmen zu verzichten bzw. Reanimationsmaßnahmen nicht fortzuführen. Zusatzmaterial online Zusätzliche Informationen sind in der Online-Version dieses Artikels (10.1007/s10049-021-00894-w) enthalten.

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Association of Rewarming Rate on Neonatal Outcomes in Extremely Low Birth Weight Infants with Hypothermia

Cited by 18 publications

References 25 publications

Improving Thermal Support in Very and Extremely Low Birth Weight Infants during Interfacility Transport

Improving Thermal Support in Very and Extremely Low Birth Weight Infants during Interfacility Transport

Neonatal Life Support 2020 International Consensus on Cardiopulmonary Resuscitation and Emergency Cardiovascular Care Science With Treatment Recommendations

Versorgung und Reanimation des Neugeborenen nach der Geburt

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