Optimising Admission Temperatures of Preterm Infants to the Neonatal Intensive Care Unit. Dr Jayne Sage, Dr Rebekka Jones, Dr Claire Rose Neonatal Intensive Care Unit, Southmead Hospital, North Bristol NHS Trust, Bristol, UK Preterm infants are highly susceptible to heat loss following delivery. The aim is to maintain an infant’s temperature between 36.5°C and 37.5°C. This is measured on admission to the neonatal intensive care unit (NICU). Temperature outside of this range is associated with an increased risk of morbidity and mortality. BACKGROUND In our unit, the previous standard of care for infants born at less than 32 weeks gestation, was to use a food grade plastic bag alongside an overhead heat source. With this care just 73/162 (45 %) of infants had an optimal admission temperature. PHASE 1 – BASELINE The Project PHASE 2 – POLYETHYLENE SUIT In September 2016 a double-layer polyethylene suit was introduced for use during stabilisation. This reduced the proportion of infants with a low admission temperature from 71/162 (43.9%) to 33/166 (19.9%). There was however, a significant increase in infants with a high temperature, resulting in only 88/166 (53%) having an optimum admission temperature. PHASE 3 – THERMAL CARE BUNDLE To further improve control continuous skin temperature monitoring during stabilisation was introduced in February 2019. This allowed for adjustment of the overhead heat source. The new set up was rolled out through educational posters, use of simulation time and discussion at daily safety briefings. Since introduction 37/53 (70%) of infants had an optimal admission temperature. We continue to raise awareness of how to support temperature at delivery and how best to respond to temperature monitoring in order to further improve results. Funds are also being sought to upgrade all monitors on delivery suite to provide temperature monitoring. Skin temperature monitor placed in right axilla alongside saturation monitor. Set up of preterm infant in double layer polyethylene suit receiving monitoring. 34 35 36 37 38 39 40 43.9% Admission Temperature (°C) 11.1% 27.1% 15.0% 45.0% 53.0% Baseline Polyethylene Suit Thermal care bundle 70.0% 19.9% 15.0% Scatter Plot Key [% infants temperature >37.5 °C] [% infants temperature 36.5 - 37.5 °C] [% infants temperature <36.5 °C]

Optimising Admission Temperatures of Preterm Infants to the Neonatal …€¦ · Infants to the Neonatal Intensive Care Unit. Dr Jayne Sage, Dr Rebekka Jones, Dr Claire Rose Neonatal

Download PDF Report

Upload
others
View
9
Download
0

Embed Size (px)

Citation preview

Page 1: Optimising Admission Temperatures of Preterm Infants to the Neonatal …€¦ · Infants to the Neonatal Intensive Care Unit. Dr Jayne Sage, Dr Rebekka Jones, Dr Claire Rose Neonatal

Optimising Admission Temperatures of Preterm Infants to the Neonatal Intensive Care Unit.

Dr Jayne Sage, Dr Rebekka Jones, Dr Claire RoseNeonatal Intensive Care Unit, Southmead Hospital, North Bristol NHS Trust, Bristol, UK

Preterm infants are highly susceptible to heat loss following delivery. The aim is to maintain an infant’stemperature between 36.5°C and 37.5°C. This is measured on admission to the neonatal intensive care unit(NICU). Temperature outside of this range is associated with an increased risk of morbidity and mortality.

BACKGROUND

In our unit, the previous standard ofcare for infants born at less than 32weeks gestation, was to use a foodgrade plastic bag alongside anoverhead heat source. With this carejust 73/162 (45 %) of infants had anoptimal admission temperature.

PHASE 1 – BASELINE

The Project

PHASE 2 –POLYETHYLENE SUIT

In September 2016 a double-layerpolyethylene suit was introducedfor use during stabilisation. Thisreduced the proportion of infantswith a low admission temperaturefrom 71/162 (43.9%) to 33/166(19.9%). There was however, asignificant increase in infants with ahigh temperature, resulting in only88/166 (53%) having an optimumadmission temperature.

PHASE 3 –THERMAL CARE BUNDLE

To further improve controlcontinuous skin temperaturemonitoring during stabilisation wasintroduced in February 2019. Thisallowed for adjustment of theoverhead heat source. The new setup was rolled out througheducational posters, use ofsimulation time and discussion atdaily safety briefings. Sinceintroduction 37/53 (70%) of infantshad an optimal admissiontemperature. We continue to raiseawareness of how to supporttemperature at delivery and howbest to respond to temperaturemonitoring in order to furtherimprove results. Funds are alsobeing sought to upgrade allmonitors on delivery suite toprovide temperature monitoring.

Skin temperature monitor placed in right axilla alongside saturation monitor.

Set up of preterm infant in double layer polyethylene suit receiving monitoring.

43.9%

mis

sio

n T

emp

erat

ure

(°C

) 11.1% 27.1% 15.0%

45.0% 53.0%