BACKGROUND AND OBJECTIVE: Hypothermia during delivery room stabilization of very low birth weight (VLBW) newborns is independently associated with mortality, yet it occurred frequently both in collaborative networks and at our institution. We aimed to attain admission temperatures in the target range of 36°C to 38°C in $90% of inborn VLBW neonates through implementation of a thermoregulation bundle.METHODS: This quality improvement project extended over 60 consecutive months, using sequential plan-do-check-act cycles. During the 14 baseline months, we standardized temperature measurements and developed the Operation Toasty Tot thermoregulation bundle (including consistent head and torso wrapping with plastic, warmed blankets, and a closed stabilization room). We introduced this bundle in month 15 and added servo-controlled, battery-powered radiant warmers for stabilization and transfer in month 21. We provided results and feedback to staff throughout, using simple graphics and control charts.RESULTS: There were 164 inborn VLBW babies before and 477 after bundle implementation. Introduction and optimization of the bundle decreased the incidence of hypothermia, with rates remaining in the target range for the last 13 study months. The incidence of temperatures .38°C was ∼2% both before and after bundle implementation.CONCLUSIONS: This thermoregulation bundle resulted in sustained improvement in normothermia rates during delivery room stabilization of VLBW newborns. Our benchmark goal of $90% admission temperatures above 36°C was met without increasing hyperthermia rates. Because these results compare favorably with those of recently published research or improvement collaboratives, we aim to maintain our performance through routine surveillance of admission temperatures. Pediatrics 2014;133:e218-e226 Dr Pinheiro contributed to the initial design and implementation of the project, collaborated in data acquisition, performed interim and final data analyses and interpretation, and drafted the initial manuscript; Ms Furdon contributed to the initial design and implementation of the project, collaborated in data acquisition, performed interim data analyses and interpretation, and collaborated in the initial draft and revisions of the manuscript; Ms Boynton, Ms Dugan, and Ms Reu-Donlon contributed to the initial design and implementation of the project, collaborated in data acquisition, and reviewed and revised the manuscript; Ms Jensen contributed to the initial design and implementation of the project, performed data analyses and interpretation in the early phases of the project, and reviewed and revised the manuscript; and all authors approved the final manuscript as submitted.www.pediatrics.org/cgi

: The results associated with this isolated change in practice at our institution suggest that chemical warming packs were a useful adjunct in achieving above-average rates of normothermia during delivery room resuscitation of VLBW newborns. Their potential adverse effects should be weighed against the increased risk of mortality associated with hypothermia in this population.