Objective To analyze the effect of quality improvement item (QI) on the incidence of hypothermia of very low birth weight premature infants in Neonatal Intensive Care Unit (NICU),in order to provide evidence for improving the clinical outcome of premature infants. Methods The very low birth weight premature infants (gestational age＜32 weeks and/or birth weight＜1 500 g) admitted to NICU in Liaocheng People's Hospital were enrolled in this study from 1st January,2017 to 31st January,2019.Infants whose annal temperature was lower than 36.5℃ were diagnosed with hypothermia.Infants admitted in this hospital from 1st January,2017 to 31st December,2017 were enrolled in control group(n=128),and received typical measures controlling temperature.And infants admitted in this hospital from 1st February,2018 to 31st January,2019 were selected as intervention group(n=120),whose temperature was administered through quality improvement program.The rates of prenatal conditions,hypothermia,intraventricular hemorrhage and morbidity were compared between the two groups. Results The rate of hypothermia in very low birth weight premature infants decreased from 92.5% to 40.5% during the intervention period,and the temperature of intervention group at admission was significantly higher than that of control group[(36.6±0.7) ℃ vs.(35.9±0.8)℃,t=4.54,P＜0.01)].The incidence of hypotension(43.4%) and intracranial hemorrhage(43.3%),the application of pulmonary surfactant (26.1%) and the incidence of sepsis(24.0%)in intervention group were significantly lower than those in control group (29.5%,32.9%,65.6%,41.0%,χ2=3.56,5.99,7.56,12.15,P＜0.05). Conclusion The implementation of quality improvement program based on evidence-based medicine can significantly reduce hypothermia of very low birth weight premature infants at admission and improve their clinical outcomes.
Key words
quality improvement /
hypothermia /
premature infants
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References
[1] De Almeida MF,Guinsburg R,Sancho GA,et al.Hypothermia and early neonatal mortality in preterm infants[J].J Pediatr,2014,164(2):271-275.
[2] Fatsman BR,Howell EA,Holzman I,et al.Current perspective on temperature management and hypothermia in low birth weight infants[J].J Newborn Infant Nurs,2014,14(3):50-55.
[3] De Siqueira Caldas JP,Ferri WAG,Marba STM,et al.Admission hypothermia,neonatal morbidity,and mortality:evaluation of a multicenter cohort of very low birth weight preterm infants according to relative performance of the center[J].Eur J Pediatr,2019,178(7):1023-1032.
[4] Pinheiro JM,Boynton S,Furdon SA,et al.Use of chemical warming packs during delivery room resuscitation is associated with decreased rates of hypothermia in very lowbirth-weight neonates[J].Adv Neonatal Care,2011,11(5):357-362.
[5] Bhatt DR,White R,Martin G,et al.Transitional hypothermia in preterm newborns[J].Adv Neonatal Care,2010,10(Suppl 5):15-17.
[6] Pinheiro JM,Furdon SA,Boynton S,et al.Decreasing hypothermia during delivery room stabilization of preterm neonates[J].Pediatrics,2014,133(1):e218-e226.
[7] Perlman JM,Wyllie J,Kattwinkel J,et al.Neonatal Resuscitation Chapter Collaborators.Part 7:Neonatal Resuscitation.2015 International consensus on cardiopulmonary resuscitation and emergency cardiovascular care science with treatment recommendations[J].Circulation,2015,132(16 Suppl 1):204-241.
[8] Cramer K,Wiebe N,Hartling L,et al.Heat loss prevention:a systematic review of occlusive skin wrap for premature neonates[J].J Perinatol,2005,25(12):763-769.
[9] Brown A.Applying the care group model to tuberculosis control:findings from a community-based project in Mozambique[J].Int J Tuber Lung Dis,2017,21(10):1086-1093.
[10] Yip WY,Quek BH,Fong MCW,et al.A quality improvement project to reduce hypothermia in preterm infants on admission to the neonatal intensive care unit[J].Int J Qual Health Care,2017,29(7):922-928.
[11] Reilly MC,Vohra S,Rac VE,et al.Randomized trial of occlusive wrap for heat loss prevention in preterm infants[J].J Pediatr,2015,166(2):262-268.
[12] Singh A,Duckett J,Newton T,et al.Improving neonatal unit admission temperatures in preterm babies:exothermic mattresses,polythene bags or a traditional approach?[J].J Perinatol,2010,30(1):45-49.
[13] Lee HC,Ho QT,Rhine WD.A quality improvement project to improve admission temperatures in very low birth weight infants[J].J Perinatol,2008,28(11):754-758.
[14] Lyu Y,Shah PS,Ye XY,et al.Association between admission temperature and mortality and major morbidity in preterm infants born at fewer than 33 weeks' gestation[J].JAMA Pediatr,2015,169(4):e150277.
[15] Drassinower D,Friedman AM,Obi an SG,et al.Prolonged latency of preterm premature rupture of membranes and risk of neonatal sepsis[J].Am J Obstet Gynecol,2016,214(6):743.e1-e6.
[16] Miller SS,Lee HC,Gould JB.Hypothermia in very low birth weight infants:distribution,risk factors and outcomes[J].J Perinatol,2011,31 (Suppl 1):49-56.
[17] Billimoria Z,Chawla S,Bajaj M,et al.Improving admission temperature in extremely low birth weight infants:a hospital-based multiintervention quality improvement project[J].J Perinat Med,2013,41(4):455-460.
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