• Zeenia Billimoria, Sanjay Chawla, Monika Bajaj, and Girija Natarajan.
• Division of Neonatal Perinatal Medicine, Hutzel Women’s Hospital, Wayne State University, Detroit, MI, USA.
• J Perinat Med. 2013 Jul 1;41(4):455-60.

ObjectiveTo reduce the incidence of hypothermia (admission temperatures <36°C) in extremely low birth weight (ELBW) neonates using a multi-intervention quality improvement (QI) initiative.Study DesignWe conducted a multi-intervention QI initiative to reduce hypothermia (admission temperatures <36°C) among preterm ELBW (≤1000 g birth weight) neonates born at Hutzel Women's Hospital. The QI project was conducted in three periods: period 1, traditional thermal care of drying and wrapping in towel; period 2, wrapping in plastic wrap without first drying; and period 3, periodic staff education, additional use of chemical warming mattress, and increase in operating room temperature from 20°C to 21°C. Statistical analysis included ANOVA, χ2, and logistic regression as appropriate.ResultsIn our cohort of 209 patients, baseline characteristics were comparable in the three periods except for a reduction in the need for surfactant doses in the 3rd period. Temperature on admission to the neonatal intensive care unit was significantly higher, with a reduction in hypothermia in the 3rd period. There was no patient with a temperature of ≥37.5°C. On logistic regression, with gestational age, 5-min Apgar score, and mode of delivery as covariates, time period 3 was significantly associated with a reduction in the incidence of hypothermia (P=0.02).ConclusionA concerted QI approach improved admission temperature in ELBW neonates, with more neonates in the euthermic range, without increasing the risk for hyperthermia. Such an approach could be associated with improved outcomes in this population.

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