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Enhanced rate of admission normothermia in extremely preterm newborn infants following implementation of continuous infant temperature monitoring in the delivery room

Paul Cawley 1, Lynn Jones 1, Paul Clarke 1, Priya Muthukumar 1

Institution(s)

1. Neonatal Intensive Care Unit, Norfolk & Norwich University Hospital, UK

Introduction (include hypothesis)

Neonatal hypothermia is associated with increased morbidity & mortality. [1][2] Maintaining normothermia, and preventing cold stress, is an important aspect of early newborn care. As part of enhanced monitoring of infant’s delivery room cuddles, we have implemented a continuous infant temperature monitoring Standard Operating Procedure (SOP). Aim: to assess if our new SOP has improved rates of admission normothermia (T36.5-37.5°C), compared with historic thermoregulation quality improvement cycles.

Methods (include source of funding and ethical approval if required)

Retrospective audit of inborn infants <28+0 weeks gestation. Historical data were provided by 3 previous audit cycles on our unit between 2014-2017. Contemporary data were provided by our electronic admissions system from January to May 2019. Continuous data were analysed by a two-tailed Mann-Whitney test & categorical data analysed by the Chi-square test for trend. Data are medians, and interquartile range (IQR). For continuous temperature monitoring we affix a skin temperature probe under the infant’s axilla. Thermoprotective measures in the delivery room are adjusted in direct response to infant temperature.

Results

Contemporary data n=14, historical data n= 31. Birth weight 700g [IQR 582-953], gestation 25+2 weeks [IQR 24+1-26+6].

Infants were significantly warmer on admission since starting continuous temperature monitoring, versus historical data: 37.1 Vs 36.5°C [IQR 36.8-37.3 Vs 36.0-37.0, p=0.0068]. The figure shows a statistically significant trend of improving admission normothermia, as our audit cycles have progressed. Within our contemporary cohort, two infants’ admission temperatures were out of normothermia range; one infant 36.4°C and one infant, with gram positive early onset sepsis, 38.8°C.

Enhanced rate of admission normothermia in extremely preterm newborn infants following implementation of continuous infant temperature monitoring in the delivery room

Conclusions

Within our small data series, we have observed an improving trend in admission normothermia. Continuous skin temperature monitoring started in the delivery room has enhanced our established thermoregulation care bundle and has the potential to assure admission normothermia for extremely preterm infants.

References (include acknowledgement here if appropriate)

1. Lyu Y et al. JAMA Pediatr. 2015;169(4):e150277

2. Laptook AR et al. Pediatrics. 2007; 119(3):e643-9

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