Neonatal Thermoregulation

Abstract

Background: Premature infants are poor regulators of body temperature and are subjected to environmental factors that can lead to rapid heat loss, leaving them vulnerable to an increased risk of morbidity and mortality from hypothermia. Thermoregulation protocols have proven to increase survival in preterm infants. Purpose: To evaluate a Plan-Do-Study-Act (PDSA) cycle on a previously implemented Golden Hour protocol at a military medical care facility for infants born at less than 32 weeks of gestation and weighing less than1500 g. Specific aims included the use of increased delivery/operating room temperatures and proper use of thermoregulatory devices (polyethylene bags and thermal mattress). Methods: Outcomes were analyzed and compared using a pre/postdesign. The data was collected using the neonatal intensive care unit admission worksheet. Results: Although statistical analysis was not significant, clinical significance was illustrated by a decrease in hypothermia rates on admission and at 1 hour of life. There was a 100% compliance rate with increasing delivery room/operating room temperatures and thermal mattress use. Polyethylene bag use compliance was 50%. Implications for Practice: Golden Hour protocols have proven to be an effective tool. Thermoregulation is a significant component of these protocols, and it is imperative that every step is taken to manage the environmental temperature during the birth and admission process. Implications for Research: There is a need for continued research on the impacts of thermoregulatory devices and protocols, with resulting practice and device recommendations.

Association between Neonatal Outcomes and Admission Hypothermia among Very Preterm Infants in Chinese Neonatal Intensive Care Units: A Multicenter Cohort Study

“…However, implementing a standardized approach to DR resuscitation of VPIs, such as the "Golden Hour Protocol," has been shown to reduce rates of admission hypothermia and may be beneficial to individual centers seeking to improve outcomes. 23,24 The results of this study are similar to those of previous studies, which reported a significant correlation between admission hypothermia and mortality. A cohort study conducted in Guinea-Bissau found that a body temperature below 34.5 °C significantly increased the risk of infant death by about five times in the first 7 days of life and was associated with an increased mortality rate between 8 and 56 days after birth.…”

“…However, implementing a standardized approach to DR resuscitation of VPIs, such as the “Golden Hour Protocol,” has been shown to reduce rates of admission hypothermia and may be beneficial to individual centers seeking to improve outcomes. 23 24…”

Improving Golden Hour Care Coordination

“…10,11 Because of the complexity of care that needs to be delivered within the Golden Hour, many neonatal units rely on evidence-based bundles of care, based on specific needs of the unit, for example, improving admission temperatures, or reducing rates of bronchopulmonary dysplasia or intraventricular hemorrhage. [12][13][14] Although having the right equipment available is critical to completing a quick and effective admission, emerging research suggests that teamwork may be more important than previously suggested. 5,6,15 It is critical that all members of admission teams understand their role and operate on a shared mental model.…”

“…Because of the complexity of care that needs to be delivered within the Golden Hour, many neonatal units rely on evidence-based bundles of care, based on specific needs of the unit, for example, improving admission temperatures, or reducing rates of bronchopulmonary dysplasia or intraventricular hemorrhage. 12 – 14 …”

Variation of body temperature after sponge bath in stable very low birth weight preterm neonates

“…Hypothermia is one of the common causes of morbidity and mortality in preterm infants. It may directly or indirectly lead to complications such as respiratory disturbances, metabolic derangements such as hypoglycemia, acidosis, renal failure, coagulopathy, and even death [3]. Temperature regulation in preterm infants is much more challenging than in term babies.…”