Abstract
For fragile extremely premature infants, the struggle to maintain thermoregulation is attributed to the higher ratio of body surface area to weight and an immature epidermal barrier. Hypothermia results in increased oxygen and metabolic demand, significant acid-base imbalances, cardiovascular compromise, organ dysfunction, hypoglycemia and mortality. A “Golden Hour” protocol is in place at this Midwest Level III NICU to decrease comorbidities and improve outcomes in infants born less than 30 weeks gestation. This unit’s VON data collection determined that admission temperatures for this targeted population were below the benchmark national average rates for “Golden Hour” deliveries. Respiratory water loss is a cause of hypothermia in this population and is inversely proportional to the humidity of inspired gas.|The purpose of this quality improvement project was to implement and evaluate the use of heated and humidified gases in the resuscitation of infants born less than 30 weeks gestation. The use of heated and humidified gas can reduce the incidence of hypothermia on admission. When used in collaboration with the current “Golden Hour” protocol, the primary outcome measurement was a normothermic admission temperature within the range of 36.5-37.5°C.|Project interventions included the initiation of a heated humidifier in two designated Labor and Delivery OR resuscitation rooms. This included the purchasing and installation of two new heated circuit attachments for the Fisher & Paykel Neopuff T-piece resuscitator used at this facility. Educational material regarding the purpose of the project as well as the equipment operation was completed for all participating NICU staff, which included neonatal nurse practitioners, registered nurses and respiratory therapists. Inclusion criteria involved infants born less than 30 weeks gestation, who received heated and humidified oxygen at an optimal temperature of 37.0°C in the delivery room and a documented admission temperature within the first hour of life.A retrospective chart review of pre and post-intervention admission temperatures was collected and analyzed. Post-intervention data collection included 20 infants born between October 1, 2018 and January 10, 2019. Seventeen of the 20 infants met qualification criteria. Of those infants, 13 (76.4%) had normothermic admission temperatures between 36.5-37.5°C, two (11.8%) were < 36.5°C and two (11.8%) were >37.5°C.|This quality improvement project suggests that the use of heated and humidified oxygen in this patient population is an effective method for reducing the risk of admission hypothermia when used in conjunction with other golden hour thermoregulatory techniques. Secondary outcomes, which require a longer duration for accurate data collection, will continue to be measured and resulted at a later date. Studies suggest that the use of inspired humidified gas may potentially prevent hypoglycemia as well as pulmonary inflammatory markers, decrease airway resistance, and increase compliance. Future research could evaluate any long-term benefits of this practice change including, but not limited to, decreasing respiratory co-morbidities.