Proposed Topic (Most preferred): :
Clinical Safety and Quality Service I (Projects aiming to improve efficiency and effectiveness of care delivery to meet international standards)
Proposed Topic (Second preferred): :
Clinical Safety and Quality Service III (Projects aiming at quality service to patients and their carers)
Authors (including presenting author) :
So HY(1), Chan MC(1)
Affiliation :
(1) Department of Paediatrics and Adolescent Medicine, Kwong Wah Hospital
Introduction :
Extremely preterm infants (i.e. ≤ 28 weeks) or extreme low birth weight infants (birth weight ≤ 1kg) always require active resuscitation at birth. Hypothermia (body temperature <36.5C) at birth of preterm infants has been associated with increased risk of hypoglycaemia, metabolic acidosis, high grade intraventricular haemorrhage (IVH) and mortality. Despite use of sophisticated equipment at resuscitation for high-risk infants, still up to 50% of extremely preterm infants were found hypothermia upon NICU admission. In order to prevent hypothermia in extremely preterm infants, support from a trained neonatal nurse (completed Post-registered Certificate Course in Neonatal Intensive Care Nursing and Neonatal Resuscitation Program) at delivery was commenced in July 2022 during office hours.
Objectives :
Support from a trained neonatal nurse at delivery can prevent hypothermia of extremely preterm infant.
Methodology :
A retrospective cohort study of NICU infants was performed during July 2022 to November 2023. Infants were included if they were inborn and born at ≤28 weeks GA or birth weight ≤ 1kg. All the neonatal resuscitation were attended by at least 2 Paediatricians and 3 obstetric nurses, latest NRP guideline (8th edition) was followed. Infants were divided into two groups, the intervention group and control group. In the intervention group, a trained neonatal nurse was present at the delivery to help neonatal resuscitation. In the control group, no neonatal nurse was available at the delivery. Otherwise, infants in both groups received same medical and nursing care in delivery room. Data about gender, gestational age, body weight, rectal temperature, time to NICU arrival, SNAPPE II score, SNAPPE II Predicted Death Rate, CRIB II, CRIB II Predicted Death Rate were retrieved. For group comparisons, Mann-Whitney U test was used because data were generally not normally distributed. Chi-squared test was used for binary outcomes.
Result & Outcome :
During the study period, total of 33 infants were met our inclusion criteria. The median patient age was 26.6 weeks (interquartile range [IQR] 25.7 to 28.0 weeks); male to female ratio was 0.9 to 1. There were 16 infants identified in the intervention group, whereas 17 infants were identified in the control group. The median rectal temperature in the intervention group was significantly higher than those in the control group (36.8C [IQR 36.7 to 37.4] vs 35.8C, [IQR 35.4 to 36.0], p<0.001). Statistical analysis did not show significant differences among other data. Neonatal resuscitation in delivery room with a trained neonatal nurse’s support significantly reduced hypothermia of extremely preterm infants upon NICU admission.
