Nurse-initiated Enhancement Program on Reducing the Time Required to Achieve Normothermia in Hypothermic Preterm Infants at Their Initial Stabilization Period in NICU

Abstract Description

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Authors (including presenting author) :

Wong KY, Chiu GS, Bo SW, Lee WM, Koo PY

Affiliation :

Department of Paediatrics & Adolescent Medicine, QMH

Introduction :

Neonatal hypothermia is associated with increased mortality and morbidity rates. Preterm infants are particularly at risk of hypothermia as they have immature skin, large surface area to volume ratio, inadequate subcutaneous fats, and under-developed thermoregulatory mechanism etc. 61% of preterm infants admitted to a local NICU were hypothermic on admission in 2017. From May-July 2017, the average time required for hypothermic preterm infants to return to normothermia at the initial stabilization period in NICU was 3.96 hours. Evidences showed that prolonged hypothermia was associated with increased morbidity and risk of infection. A nurse-initiated enhancement program aiming at reduction of the time required for hypothermic preterm infants return to normothermia during initial stabilization period in NICU was therefore developed.

Objectives :

(1) To determine the effect of the intervention program on shortening the average time required for hypothermic preterm infants to achieve normothermia after NICU admission (2) To reinforce NICU nurses’ knowledge on neonatal thermoregulation (3) To detect any risk factor that associate with the average time required for hypothermic preterm infants to achieve normothermia after NICU admission

Methodology :

(1) Form a thermoregulation workgroup (2) To retrieve data from the Clinical Information System (3) Develop a flowchart and checklist for the program (4) Provide small group discussion and education session to reinforce the NICU nurses’ knowledge and management on neonatal thermoregulation (5) Develop a pre-& post-test questionnaire to identify knowledge on neonatal thermoregulation. (6) Implement the new workflow. Monitor the implementation process and refine the guidelines accordingly. Monitor staff's compliance in using the checklist by the workgroup members regularly. (7) Collect data on the admission temperature of preterm infants and the duration to achieve normothermia between November 2017 and June 2018, analyze the data accordingly.

Result & Outcome :

This program was carried out since November 2017. From the pre-test and post-test result, the education session can improve the nurse's knowledge on neonatal thermoregulation by 52% (p< 0.001, paired t-test). The average time required for hypothermic preterm infants to return to normothermia during initial stabilization period in NICU was reduced by 2.63 hours (p< 0.001, 95% CI 1.30-3.97, independent t-test). After controlling the effect of body weight and the gestation age of the infants, both intervention (p< 0.001) and gestation age (p< 0.001) were a significant factor that associate with the time required for hypothermic preterm infants to achieve normothermia. Conclusion: This program can significantly reduce the average time required for hypothermic preterm infants to achieve normothermia after NICU admission, therefore, it is suggested that this program can be used in other NICU setting. This program also detected that extreme prematurity is a significant risk factor of prolonged period of hypothermia. Further study is required to investigate the association between the admission temperature of preterm infant and average time required for rewarming hypothermic preterm infants. In the future, it is recommended to evaluate the sustainability of the program.