The effect of thermoregulation quality improvement initiatives on the admission temperature of premature/very low birth‐weight infants in neonatal intensive care units: A systematic review

Abstract

Purpose The purpose of this review was to ascertain the impact of thermoregulation quality improvement initiatives (QIs) on the admission temperatures of premature/very‐low‐birth‐weight infants in neonatal intensive care units (NICUs). Methods A systematic search of databases Cumulative Index to Nursing and Allied Health Literature, Medline, Embase, and the Cochrane library was carried out. Specific inclusion and exclusion criteria were adhered to, with no publication date limitations added. The chosen studies were examined for quality, data were extracted and analysed, before a narrative synthesis was performed. The last search occurred on January 7, 2019, with PRISMA flow diagrams completed for identified studies. Results Ten studies of varying methodology design were included in this review. Variations of thermoregulation interventions were included in the 10 studies. Nevertheless, all of them demonstrated that admission temperature rates can be significantly improved by implementing a thermoregulation QI. The multidisciplinary team and ongoing education were seen as much needed components to the overall sustainability, and continuing success of the QI's. Practical Implications This systematic review determines that thermoregulation QIs can positively impact the admission temperatures of premature/very‐low‐birth‐weight infants in the NICU. Prevention of hypothermia is aimed at reducing the risks of developing major neonatal morbidities. The pooling of the results from the 10 studies helps in the sharing of outcome measures and thus, improving quantitative synthesis. More frequent monitoring of the axillary temperature would help in preventing hypothermia and hyperthermia occurring. Ongoing education and staff training are essential for managing thermoregulation successfully. Examining the compliance rates to such quality initiatives, and the variations in interventions would benefit from further research to ensure better standardisation of clinical practice.

Reducing Admission Hypothermia in Neonates Born at Less Than 32 Weeks or 1500 g

“…While this team was able to moderately reduce admission hypothermia of their neonates with a checklist, other teams have had even greater success in reducing their admission hypothermia by combining checklists/workflows with education and specific thermoregulation supports such as the chemical mattress and polyurethane bags 24,28,29. The findings from this QI project are consistent with those of the teams that have done admission thermoregulation interventions that have shown that bundled care, along with targeted thermal supports (eg, polyurethane bags, polyurethane hats, chemical mattresses) reduce NICU admission hypothermia 10,13,23. In this project, the QI team chose to expand the inclusion criteria of the thermoregulation bundle (chemical mattress, polyurethane bag, and polyurethane-lined hat) to include all neonates born less than 1500 g or at less than 32 weeks, beyond the suggestion of less than 32 weeks by the NRP 19.…”

Skin-to-Skin Contact for Transferring Preterm Infants from the Delivery Room to the Neonatal Intensive Care Unit Is Promising Despite Moderate Heat Loss during the Procedure

“…35 The combination of all methods recommended by international guidelines with multiprofessional involvement has been found to have the best positive impact on thermal conservation through quality improvement procedures. [36][37][38]…”

Nursing Care of an Extremely Preterm Infant with Sodium Taurocholate Cotransporting Polypeptide Deficiency: A Case Report

“…Appropriate temperature intervention strategies can effectively prevent the occurrence of early hypothermia in premature infants, improve the quality of life of premature infants, and reduce early complications [18]. The 2015 neonatal resuscitation guidelines clearly suggest that premature infants should avoid overheating during resuscitation or when keeping warm [19].…”