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Bi SY, Yu YH, Li C, Xu P, Xu HY, Li JH, Liu QY, Li M, Liu XJ, Wang H. A standardized implementation of multicenter quality improvement program of very low birth weight newborns could significantly reduce admission hypothermia and improve outcomes. BMC Pediatr 2022; 22:281. [PMID: 35568937 PMCID: PMC9107002 DOI: 10.1186/s12887-022-03310-5] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/10/2021] [Accepted: 04/27/2022] [Indexed: 11/12/2022] Open
Abstract
Background Admission hypothermia (AH, < 36.5℃) remains a major challenge for global neonatal survival, especially in developing countries. Baseline research shows nearly 89.3% of very low birth weight (VLBW, < 1500 g) infants suffer from AH in China. Therefore, a prospective multicentric quality improvement (QI) initiative to reduce regional AH and improve outcomes among VLBW neonates was implemented. Methods The study used a sequential Plan—Do—Study—Act (PDSA) approach. Clinical data were collected prospectively from 5 NICUs within the Sino-Northern Neonatal Network (SNN) in China. The hypothermia prevention bundle came into practice on January 1, 2019. The clinical characteristics and outcomes data in the pre-QI phase (January 1, 2018– December 31, 2018) were compared with that from the post-QI phase (January 1, 2019–December 31, 2020). Clinical characteristics and outcomes data were analyzed. Results A total of 750 in-born VLBW infants were enrolled in the study, 270 in the pre-QI period and 480 in the post- QI period, respectively. There were no significant differences in clinical characteristics of infants between these two phases. Compared with pre-QI period, the incidence of AH was decreased significantly after the QI initiative implementation in the post-QI period (95.9% vs. 71.3%, P < 0.01). Incidence of admission moderate-to-severe hypothermia (AMSH, < 36℃) also decreased significantly, manifesting a reduction to 38.5% in the post-QI (68.5% vs 30%, P < 0.01). Average admission temperature improved from after QI (35.5 \documentclass[12pt]{minimal}
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\begin{document}$$\pm$$\end{document}± 0.6℃, P < 0.01). There was no increase in proportion the number of infants with a temperature of > 37.5 °C or thermal burns between the two groups. The risk ratio of mortality in infants during the post-QI period was significantly lower in the post-QI period as compared to the pre-QI period [adjusted risk ratio (aRR): 0.26, 95% confidence interval (CI): 0.13–0.50]. The risk ratio of late-onset neonatal sepsis (LOS) also significantly lowered in the post-QI period (aRR: 0.66, 95% CI: 0.50–0.87). Conclusion Implementation of multicentric thermoregulatory QI resulted in a significant reduction in AH and AMSH in VLBW neonates with associated reduction in mortality. We gained a lot from the QI, and successfully aroused the attention of perinatal medical staff to neonatal AH. This provided a premise for continuous quality improvement of AH in the future, and might provide a reference for implementation of similar interventions in developing countries. Trial registration Trial registration number: ChiCTR1900020861. Date of registration: 21 January 2019(21/01/2019). Prospectively registered. Supplementary Information The online version contains supplementary material available at 10.1186/s12887-022-03310-5.
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Affiliation(s)
- Shu-Yu Bi
- Department of Neonatology, Shandong Provincial Hospital, Cheeloo College of Medicine, Shandong University, Jinan, 250021, Shandong, China
| | - Yong-Hui Yu
- Department of Neonatology, Shandong Provincial Hospital, Cheeloo College of Medicine, Shandong University, Jinan, 250021, Shandong, China. .,Department of Neonatology, Shandong Provincial Hospital Affiliated to Shandong First Medical University, Jinan, 250021, China.
| | - Cong Li
- Department of Neonatology, Liaocheng People's Hospital, Liaocheng, 252000, Shandong, China
| | - Ping Xu
- Department of Neonatology, Liaocheng People's Hospital, Liaocheng, 252000, Shandong, China
| | - Hai-Yan Xu
- Department of Neonatology, The First Affiliated Hospital of Shandong First Medical University, Jinan, 250014, Shandong, China
| | - Jia-Hui Li
- Department of Neonatology, The First Affiliated Hospital of Shandong First Medical University, Jinan, 250014, Shandong, China
| | - Qiong-Yu Liu
- Department of Neonatology, Women and Children's Healthcare Hospital of Linyi, Linyi, 276000, Shandong, China
| | - Min Li
- Department of Neonatology, Women and Children's Healthcare Hospital of Linyi, Linyi, 276000, Shandong, China
| | - Xin-Jian Liu
- Department of Neonatology, Hebei Petro China Central Hospital, Langfang, 065000, Hebei, China
| | - Hui Wang
- Department of Neonatology, Hebei Petro China Central Hospital, Langfang, 065000, Hebei, China
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Smith S, Keltner C, Stikes R, Hayes P, Crawford TN. Comparison of Axillary and Temporal Artery Thermometry in Preterm Neonates. J Obstet Gynecol Neonatal Nurs 2018; 47:352-361. [PMID: 29625020 DOI: 10.1016/j.jogn.2018.02.013] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/01/2018] [Indexed: 11/17/2022] Open
Abstract
OBJECTIVE To compare the accuracy of infrared temporal artery thermometry with axillary thermometry in a cohort of preterm neonates between 28 and 36 weeks postmenstrual age. DESIGN Descriptive repeated measures design with randomization to temperature measurement order. SETTING Level III NICU in the Central/Southeastern United States. PARTICIPANTS Sixty-eight neonates born between 28 weeks and 36 weeks postmenstrual age cared for in incubators or open cribs. METHODS Neonates were randomly assigned to temperature measurement order (axillary followed by temporal artery or temporal artery followed by axillary). Temperature pairs were taken once during the day shift and once during the night shift. Behavioral states were assessed before, during, and after temperature measurement. RESULTS Neonates were predominantly female (64.7%) with a mean age of 6.6 days and a mean gestational age of 32.7 weeks, and most were cared for in incubators (n = 55). Noninferiority was observed between the two temperature methods (Holm-Bonferroni criterion = .025, p < .001). There was no statistically significant difference in the behavioral states of the neonates between the two temperature methods. It took nurses significantly longer to use the axillary thermometer than to use the temporal artery thermometer (p < .001). CONCLUSION Temporal artery temperature measurements were as accurate as axillary temperature measurements in low-birth-weight neonates in the NICU. Nurses spent less time measuring with the temporal artery method than with the axillary method.
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Axillary temperatures in full-term newborn infants: using evidence to guide safe and effective practice. Adv Neonatal Care 2013; 13:361-8. [PMID: 24042144 DOI: 10.1097/anc.0b013e3182a14f5a] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
PURPOSE Although the American Academy of Pediatrics and the American Congress of Obstetricians and Gynecologists recommend obtaining temperature in newborn infants via the axilla, controversy still exists whether to obtain rectal or axillary temperatures. Of concern is the risk of perforating the rectum or colon during rectal temperature-taking. The purpose of this study was to explore the accuracy of electronic thermometer measuring temperature in the axilla compared with the rectum in full-term newborn infants. DESIGN This was an agreement study involving a purposive sample of newborn infants who were greater than 37 weeks' gestation. The general care nursery was located in a large, urban Midwestern academic medical center, and data collection occurred between May 2010 and August 2010. METHODS On admission to the general care nursery, both axillary and rectal temperatures were taken using the FasTemp device by Filac Electronic. Axillary temperatures were taken first, followed immediately by rectal temperature. Descriptive statistics, Pearson correlations, and scatter plots were computed. RESULTS In 69 newborns, the mean difference between rectal and left axilla temperatures was 0.23°C. There was a significant correlation between rectal temperature and the body temperature for the left axilla (r = 0.786; P = .01). CONCLUSIONS These preliminary data support the use of left axillary temperature measurement in the full-term newborn infant in the first few days of life to provide a safe and accurate alternative to rectal temperatures. CLINICAL RELEVANCE Nurses caring for newborn infants now have evidence showing that temperature-taking in the left axilla is an alternative to using rectal temperatures, possibly minimizing discomfort and potential risk of perforation.
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