The impact of a quality improvement project to reduce admission hypothermia on mortality and morbidity in very low birth weight infants

Sharma, Deepak; Murki, Srinivas; Kulkarni, Dattatray; Pawale, Dinesh; Vardhelli, Venkateshwarlu; Anne, Rajendra Prasad; Oleti, Tejo Pratap; Deshabhotla, Saikiran

doi:10.1007/s00431-020-03711-7

Cited by 10 publications

(22 citation statements)

References 18 publications

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“…Neonatal sepsis being linked to HT could be attributed to facts reported in the adult population undergoing surgery, where peri-operative HT was found to propagate post-operative infectious complications through temperature-mediated impaired immune function [ 13 ]. In a quality improvement project, the risk of nosocomial sepsis was significantly lowered in the period after the intervention to reduce neonatal HT [ 25 ]. However, a number of confounding factors have been established to contribute to the development of sepsis including the length of hospital stay and level of prematurity of the infant [ 36 ].…”

Section: Discussionmentioning

confidence: 99%

“…These interventions that have been proposed to prevent HT in newborn infants include using a plastic cap, polyethylene bag wrapping, thermal mattress, controlling the room temperature, and active warming during cesarean delivery [ 9 , 17 , 23 , 24 ]. A quality improvement project on the implementation of thermoregulatory interventions showed a significant reduction of neonatal HT, which in turn improved neonatal outcomes [ 25 ].…”

Section: Introductionmentioning

confidence: 99%

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Outcomes of neonatal hypothermia among very low birth weight infants: a Meta-analysis

Mohamed

Ahmed

Khidir

et al. 2021

matern health, neonatol and perinatol

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Background Neonatal admission hypothermia (HT) is a frequently encountered problem in neonatal intensive care units (NICUs) and it has been linked to a higher risk of mortality and morbidity. However, there is a disparity in data in the existing literature regarding the prevalence and outcomes associated with HT in very low birth weight (VLBW) infants. This review aimed to provide further summary and analyses of the association between HT and adverse clinical outcomes in VLBW infants. Methods In July 2020, we conducted this review according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. A systematic database search was conducted in MEDLINE (PubMed), Google Scholar, ScienceDirect, World Health Organization Virtual Health Library, Cochrane Library databases, and System for Information on Grey Literature in Europe (SIGLE). We included studies that assessed the prevalence of HT and/or the association between HT and any adverse outcomes in VLBW infants. We calculated the pooled prevalence and Odds Ratio (OR) estimates with the corresponding 95% Confidence Interval (CI) using the Comprehensive meta-analysis software version 3.3 (Biostat, Engle-wood, NJ, USA; http://www.Meta-Analysis.com). Results Eighteen studies that fulfilled the eligibility criteria were meta-analyzed. The pooled prevalence of HT among VLBW infants was 48.3% (95% CI, 42.0–54.7%). HT in VLBW infants was significantly associated with mortality (OR = 1.89; 1.72–2.09), intra-ventricular hemorrhage (OR = 1.86; 1.09–3.14), bronchopulmonary dysplasia (OR = 1.28; 1.16–1.40), neonatal sepsis (OR = 1.47; 1.09–2.49), and retinopathy of prematurity (OR = 1.45; 1.28–1.72). Conclusion Neonatal HT rate is high in VLBW infants and it is a risk factor for mortality and morbidity in VLBW infants. This review provides a comprehensive view of the prevalence and outcomes of HT in VLBW infants.

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Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Outcomes of neonatal hypothermia among very low birth weight infants: a Meta-analysis

Mohamed

Ahmed

Khidir

et al. 2021

matern health, neonatol and perinatol

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“…Countries are working to standardize temperature management procedures by QI to reduce hypothermia and improve outcomes [13][14][15][16][17]37]. A QI study from a single center in Indian for 6 months shows overall admission hypothermia decreased by QI from 82% to 45%, and moderate hypothermia reduced from 46% to <10% (P< 0.001) with signi cant reduction in incidence of IVH (13% Vs 4.7%), LOS (38% Vs 19%) and metabolic acidosis (43% Vs 28%) [37].…”

Section: Discussionmentioning

confidence: 99%

“…Besides, how to maximize the effectiveness of each intervention depends on the good compliance and execution and feedback of thermal insulation measures [7,25,29,[15][16][24][25][26][27]. In our study, we pay more attention to the consistency and completeness of the implementation of measures.…”

Section: Discussionmentioning

confidence: 99%

“…In order to improve outcomes, recognised quality improvement programs of temperature management for preventing hypothermia were rising internationally, and adjusted according to the actual situation of perinatal medical centers. With remarkable results and improved prognosis, the percentage internationally of AH in researches ranged in a low level from 10-30% after QI [13][14][15][16][17]. A report from Indian made signi cant increasement in mean admission temperature of VLBW neonates (35.3 ± 0.6°C, 36.0 ± 0.8°C, and 36.4 ± 0.4°C during preintervention, intervention, and post-intervention phase) and improved composite neonatal adverse outcomes (31%, 20%, and 13.2%) by hypothermia QI project [15].…”

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confidence: 99%

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A Standardized Implementation of Multicenter Quality Improvement Program of Very Low Birth Weight Newborns Could Significantly Reduce Admission Hypothermia and Improve Outcomes Within a Certain Region in China

Bi¹,

Yu²,

Li³

et al. 2021

Preprint

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Background: Admission hypothermia (AH, <36.5℃) remains a major challenge for global neonate survival, especially in China. Due to high incidence of reginal AH, we developed a prospective multicenter quality improvement (QI) initiative to reduce regional AH and evaluate the impact on outcome among VLBW neonates.Methods: The study used sequential Plan - Do - Study - Act (PDSA) approach. Clinical data were collected prospectively with 5 NICUs from Sino-Northern Neonatal Network (SNN) in China. Bundle come into practice since January 1, 2019. The clinical data in pre-QI phase (January 1, 2018– December 31, 2018) were compared with post-QI phase (January 1, 2019–December 31, 2020). Clinical characteristics and outcomes data were analysed.Results: A total of 750 in-born VLBW infants were enrolled in the study, 270 in pre-QI period and 480 in post- QI period, respectively. There had no significant differences in clinical characteristics in two phases. Compared with pre-QI period, the percentage of AH decreased in the QI period (95.9 %vs 71.3%, P < 0.01). Admission mod-severe hypothermia (AMSH) was improved significantly, reduced by 38.5% after QI (68.5 %vs 30%, P < 0.01). Average admission temperature improved after QI [36.0 ˚C（35.8˚C，36.5˚C）vs 35.5 ˚C（35.2 ˚C，36.0 ˚C）, P < 0.01 ]. No significant increase in AH rate and thermal burns (0.4%VS 0%). Risks of mortality and late-onset neonatal sepsis (LOS) were significantly lower in post-QI period as compared to pre-QI period (aRR 0.19, 95% CI 0.09–0.39; aRR 0.55, 95% CI 0.41–0.80) whether adjusting for birth weight (BW), gestational age (GA)，small for gestational age (SGA), Apgar score at 5 min < 7.Conclusion：Implementation of multicenter thermoregulatory QI help in significant reduction of AH and AMSH of VLBW neonates within a certain area, which in turn can help to improve reginal neonatal outcomes. We gained a lot from QI, learned and explored a suitable method to continuous QI, this may provide reference for similar developing countries.

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Maintaining normothermia immediately after birth in preterm infants <34 weeks’ gestation: A systematic review and meta-analysis

Ramaswamy,

Dawson,

de Almeida

et al. 2023

Resuscitation

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The impact of a quality improvement project to reduce admission hypothermia on mortality and morbidity in very low birth weight infants

Cited by 10 publications

References 18 publications

Outcomes of neonatal hypothermia among very low birth weight infants: a Meta-analysis

Outcomes of neonatal hypothermia among very low birth weight infants: a Meta-analysis

A Standardized Implementation of Multicenter Quality Improvement Program of Very Low Birth Weight Newborns Could Significantly Reduce Admission Hypothermia and Improve Outcomes Within a Certain Region in China

Maintaining normothermia immediately after birth in preterm infants <34 weeks’ gestation: A systematic review and meta-analysis

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