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

Abstract

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.

Hypothermia in Preterm Newborns: Impact on Survival

“… 27 Similarly, in high-income countries, a population-based cohort study in USA showed a more than 10 times higher risk of mortality in VLBW infants compared to normal weight, whereas in babies born weighing between 1500 and 2000 g, mortality was 4 times higher. 28 …”

“…In the HEAT trial at the Leiden University Medical Center, in Holland, infants with hypothermia at birth and at the time of admission also continued to be hypothermic longer than those without hypothermia. 28 …”

A standardized implementation of multicenter quality improvement program of very low birth weight newborns could significantly reduce admission hypothermia and improve outcomes

“…Transport distance might vary in the actual situation depending on the locations of the delivery room or operating room across NICUs, for example, some could be on different floors of the same building, others could be even in different buildings. To solve this problem, we introduced an insulated pre-heated portable incubator for transportation in June 2019 [ 20 , 21 ], adding the pre-transport preheating process in the delivery room or operating room in a bundle.…”

Specialist paediatric transport team provided appropriate respiratory and haemodynamic support to stabilise critically ill children

“…These results are particularly important for neonates, especially premature ones, because expertly trained paediatric transport teams keep them warmer, less hypotensive and less acidotic. This improves their clinical evolution 5 …”

“…This improves their clinical evolution. 5 We concluded that the specialist paediatric transport team provided appropriate respiratory and haemodynamic support to stabilise critically ill children. More than 50% required intensive care, but the complication rate was low.…”