title: Reducing hypothermia in preterm infants following delivery.
abstract: BACKGROUND
  Moderate hypothermia (temperature <36°C) at birth is common in premature infants and is associated with increased mortality and morbidity.
  
  
  METHODS
  A multidisciplinary practice plan was implemented to determine in premature infants <35 weeks old whether a multifaceted approach would reduce the number of inborn infants with an admitting axillary temperature <36°C by 20% without increasing exposure to a temperature >37.5°C. The plan included use of occlusive wrap a transwarmer mattress and cap for all infants and maintaining an operating room temperature between 21°C and 23°C. Data were obtained at baseline (n = 66), during phasing in (n = 102), and at full implementation (n = 193).
  
  
  RESULTS
  Infant axillary temperature in the delivery room (DR) increased from 36.1°C ± 0.6°C to 36.2°C ± 0.6°C to 36.6°C ± 0.6°C (P < .001), and admitting temperature increased from 36.0°C ± 0.8°C to 36.3°C ± 0.6°C to 36.7°C ± 0.5°C at baseline, phasing in, and full implementation, respectively (P < .001). The number of infants with temperature <36°C decreased from 55% to 6.2% at baseline versus full implementation (P < .001), and intubation at 24 hours decreased from 39% to 17.6% (P = .005). There was no increase in the number of infants with a temperature >37.5°C over time. The use of occlusive wrap, mattress, and cap increased from 33% to 88% at baseline versus full implementation. Control charts showed significant improvement in DR ambient temperature at baseline versus full implementation.
  
  
  CONCLUSIONS
  The practice plan was associated with a significant increase in DR and admitting axillary infant temperatures and a corresponding decrease in the number of infants with moderate hypothermia. There was an associated reduction in intubation at 24 hours. These positive findings reflect increased compliance with the practice plan.
authors.affiliation: Division of Newborn Medicine, Department of Pediatrics, Weill Cornell Medical College, New York, New York;
authors.forename: Anne
authors.initials: A
authors.lastname: Russo
authors.forename: Mary
authors.initials: M
authors.lastname: McCready
authors.forename: Lisandra
authors.initials: L
authors.lastname: Torres
authors.forename: Claudette
authors.initials: C
authors.lastname: Theuriere
authors.forename: Susan
authors.initials: S
authors.lastname: Venturini
authors.forename: Morgan
authors.initials: M
authors.lastname: Spaight
authors.forename: Rae Jean
authors.initials: RJ
authors.lastname: Hemway
authors.forename: Suzanne
authors.initials: S
authors.lastname: Handrinos
authors.forename: Deborah
authors.initials: D
authors.lastname: Perlmutter
authors.forename: Trang
authors.initials: T
authors.lastname: Huynh
authors.forename: Amos
authors.initials: A
authors.lastname: Grunebaum
authors.forename: Jeffrey
authors.initials: J
authors.lastname: Perlman
mesh_terms: D003696:Delivery Rooms; D006801:Humans; D007035:Hypothermia / Q000517:prevention & control*; D007231:Infant, Newborn; D007235:Infant, Premature, Diseases / Q000517:prevention & control*
keywords: hypothermia; newborn; quality improvement; temperature