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.

34

35

36

37

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40

43.9%

Ad

mis

sio

n T

emp

erat

ure

(°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]