Proposed Topic (Most preferred): :
Clinical Safety and Quality Service III (Projects aiming at quality service to patients and their carers)
Proposed Topic (Second preferred): :
Clinical Safety and Quality Service I (Projects aiming to improve efficiency and effectiveness of care delivery to meet international standards)
Authors (including presenting author) :
Cheng SM(1), Tsoi CHK (1), Ho LP (1), Yeung KY (1)
Affiliation :
(1) Department of Paediatrics, Prince of Wales Hospital
Introduction :
Neonatal hypothermia, defined as a body temperature below 36.5°C, is the leading cause of neonatal morbidity such as intraventricular haemorrhage, late-onset sepsis, hypoglycaemia and mortality, especially in preterm infants. In the past two years, the rate of satisfactory admission temperature in our unit for infants less than 32 weeks of gestation was low. Therefore, effective interventions must be identified and an evidence-based thermal care protocol applicable to local context be developed to improve the temperature of preterm infants after delivery room and admission to the NICU.
Objectives :
The objectives are: 1. to identify best available evidence on the effects of thermal care interventions for very premature infants on improving the temperature of preterm infants after delivery and admission to the NICU 2. develop and implement the evidence-based thermal care protocol on improving the temperature of preterm infants after delivery and admission to the NICU 3. evaluate the effectiveness of an evidence-based thermal care intervention protocol
Methodology :
The thermal care protocol was developed after an extensive review of evidence.Prior to implementation of the protocol, staff were educated to facilitate the guideline’s dissemination and implementation.A quasi-experimental design study with a historical control group was employed. Data were collected in three periods corresponding to the pre-implementation (control group) from 01/03/2020 to 30/06/2021 and post-implementation (intervention group P1)) from 04/10/2021 to 31/10/2022 and from 01/12/2022 to 21/12/2023 (intervention P2) to evaluate effectiveness of the thermal care protocol.
Result & Outcome :
A total of 176 preterm neonates (60 in the control group and 58 in the intervention group P1 and 58 in P2) with gestational age <32 weeks were recruited. There were no statistically significant differences in gestational age, birth weight, mode of delivery, and hence baseline characteristics of infants were similar in the two groups. In P1 period, the admission temperature in the NICU was significantly higher in the intervention group than in the control group [36.4 °C (0.58) vs 36.0 °C (0.65), p=0.001]. The incidence of hypothermia was significantly decreased from 71.7% to 48%. In P2 period, the admission temperature in the NICU during that period was still significantly higher in the intervention group than in the control group [36.5 °C (0.77) vs 36.4 °C (0.58) vs 36.0 °C (0.65), p=0.001]. The incidence of hypothermia in the P2 was 36.2%. This project showed that the developed evidence-based protocol is effective in improving the temperature in premature infants with less than 32 weeks of gestation after delivery and admission to the NICU. The protocol developed in this project has become the standard of care in our unit for admitting a preterm infant.
