Authors (including presenting author) :
Cheng SM (1)
Wong CL(2)
Affiliation :
1 Department of Paediatrics, Prince of Wales Hospital
2 The Nethersole School of Nursing, Faculty of Medicine, The Chinese University of Hong Kong
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 intervention protocol applicable to local context be developed to improve the temperature of preterm infants after delivery room and admission to the NICU.
Objectives :
-Develop and implement an evidence-based protocol on improving the temperature of the preterm infants after delivery room and admission to the NICU
-Evaluate the effectiveness of the thermal care protocol
Methodology :
This study consisted of two phases. Phase I aimed to develop the thermal care protocol and training programme of nurses in NICU. A team included 5 nurses and a neonatal doctor was formed. The thermal care protocol was developed after an extensive review of evidence. Prior to implementation of the protocol, staff were offered training to facilitate the guideline’s dissemination and implementation.
Phase II adopted a quasi-experimental design with a historical control group to examine the effectiveness of the developed thermal care protocol for the improving temperature for preterm infants after delivery room and admission to the NICU. Date was collected in two periods corresponding to the pre-implementation (control group) and post-implementation (intervention group) to evaluate the neonatal outcomes. The outcomes on nurses were knowledge level of thermal care. The outcomes on preterm infants at intervention compared to the control group included: (1) temperature upon admission to the NICU; (2) temperature after admission to the NICU up to 4 hours; (3) the Apgar score; (4) blood gas; (5) mortality rate; (6) blood glucose; (7) incidence of intraventricular haemorrhage and hypothermia.
Result & Outcome :
For phase I, an evidence-based intervention protocol for the improving the temperature of preterm infants was developed based on the results of the literature review. The components of intervention included Use of occlusive wrap, polyethylene cap, keep the occlusive wrap and polyethylene cap for as long as possible and the application of temperature controlled thermal blanket. The mean score of the staff knowledge test (n=56)was significantly higher in the post-test (8.24 vs 6.67, p<0.05).
For phase II, a total of 118 preterm neonates (60 in the control group and 58 in the intervention group) <32 weeks gestational age was recruited. Result showed that 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]. For the secondary outcomes, incidence of hypothermia (temperatures <36.5 °C) was significantly lower in the intervention group (48.2 vs 73.3%, p=0.008). The incident of having IVH was lower in the intervention group (31% vs 55%) but did not reach statistical significance (p=0.147).
