Abstract
Objective
Excessive hypothermia is common in infants that receive passive cooling for hypoxic ischemic encephalopathy (HIE). Our goal was to reduce the number of infants with admission temperature <33 °C from 33% to less than 10% by December 2017.
Methods
Outcome measures included the number of infants with admission temperature <33 °C and number of infants with temperature within therapeutic range. Interventions included implementation of passive cooling guidelines and outreach education to birth hospitals and transport team. We used statistical process control chart to compare outcomes over a 3 year period.
Results
The number of infants with admission temperature <33 °C decreased from 33.3% to 5.5% (p = 0.013). The number of infants with admission temperature within target range for hypothermia therapy increased from 61.1% to 77.7% (p = 0.014). Balancing measures and complications remained unchanged.
Conclusion
Implementation of passive cooling guidelines and outreach education led to significant decrease in excessive hypothermia in infants with HIE.
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Acknowledgements
We thank the Neonatal transport team at Kentucky Children’s Hospital for their collaboration with implementation of the passive cooling guidelines. Especial thanks to Tina Mc Coy MSN, RN C-NPT, for helping developing the passive cooling guidelines for transport team and collecting the transport logs of all the subjects in this study. We also want to thank Debora Rice BSN, C-NPT for her tremendous investment in providing outreach education to all our referral hospitals. Also we would like to acknowledge Aric Schadler for his important contribution in some of the statistic calculations.
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Contributions
SA: conceptualized and designed the study. She collected data from medical records and transport logs, participated in the interpretation of the data, drafted the first version of the manuscript, reviewed the revisions and approved the final version of the manuscript as submitted. HH: participated in the interpretation of the data, selected the analysis to be used and conducted the statistical analysis. She reviewed the manuscript and approved the final version as submitted. KF: participated in conceptualization and design of the study, she coordinated all the outreach education to referring hospitals, collected and entered data, critically reviewed the manuscript and approved the final version as submitted. PG: critically reviewed the manuscript and the revisions. He approved the final version of the manuscript as submitted.
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The authors declare that they have no conflict of interest.
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This project was identified by the Kentucky Children’s Hospital Institutional Review Board as a quality improvement project and therefore exempt from review.
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Arriagada, S., Huang, H., Fletcher, K. et al. Prevention of excessive hypothermia in infants with hypoxic ischemic encephalopathy prior to admission to a quaternary care center: a neonatal outreach educational project. J Perinatol 39, 1417–1427 (2019). https://doi.org/10.1038/s41372-019-0391-0
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DOI: https://doi.org/10.1038/s41372-019-0391-0
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