Improving Delivery Room Management for Very Preterm Infants

DeMauro, Sara B.; Douglas, Emily; Karp, Kelley; Schmidt, Barbara; Patel, Jay; Kronberger, Amy; Scarboro, Russell; Posencheg, Michael A.

doi:10.1542/peds.2013-0686

Cited by 81 publications

(62 citation statements)

References 35 publications

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“…30 That study did not have a nonparticipant group for comparison. A similar single-center study found a reduction in hypothermia (defined in that study as temperature ,36°) from 55% to 6%.…”

Section: Discussionmentioning

confidence: 97%

Implementation Methods for Delivery Room Management: A Quality Improvement Comparison Study

Lee¹,

Powers

Bennett³

et al. 2014

PEDIATRICS

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WHAT'S KNOWN ON THIS SUBJECT: Quality improvement (QI) studies generally do not account for concurrent trends of improvement and it is difficult to distinguish the impact of a multihospital collaborative QI project without a contemporary control group. WHAT THIS STUDY ADDS:A multihospital collaborative QI model led to greater declines in hypothermia and invasive ventilation rates in the delivery room compared with an individual NICU QI model and NICUs that did not participate in formal QI activities. abstract BACKGROUND: There is little evidence to compare the effectiveness of large collaborative quality improvement versus individual local projects. METHODS:This was a prospective pre-post intervention study of neonatal resuscitation practice, comparing 3 groups of nonrandomized hospitals in the California Perinatal Quality Care Collaborative: (1) collaborative, hospitals working together through face-to-face meetings, webcasts, electronic mailing list, and data sharing; (2) individual, hospitals working independently; and (3) nonparticipant hospitals. The collaborative and individual arms participated in improvement activities, focusing on reducing hypothermia and invasive ventilatory support.RESULTS: There were 20 collaborative, 31 individual, and 44 nonparticipant hospitals caring for 12 528 eligible infants. Each group had reduced hypothermia from baseline to postintervention. The collaborative group had the most significant decrease in hypothermia, from 39% to 21%, compared with individual hospital efforts of 38% to 33%, and nonparticipants of 42% to 34%. After risk adjustment, the collaborative group had twice the magnitude of decrease in rates of newborns with hypothermia compared with the other groups. Collaborative improvement also led to greater decreases in delivery room intubation (53% to 40%) and surfactant administration (37% to 20%). CONCLUSIONS:Collaborative efforts resulted in larger improvements in delivery room outcomes and processes than individual efforts or nonparticipation. These findings have implications for planning quality improvement projects for implementation of evidence-based practices.

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Section: Discussionmentioning

confidence: 97%

Implementation Methods for Delivery Room Management: A Quality Improvement Comparison Study

Lee¹,

Powers

Bennett³

et al. 2014

PEDIATRICS

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“…48,55,66,[83][84][85][86][87] Eight observational studies (low-quality, downgraded for indirectness) found no association between hypothermia and IVH. 43,60,61,[88][89][90][91][92] For the important outcome of respiratory issues, there is evidence from 9 observational studies 44,48,50,67,83,[93][94][95][96] (low-quality evidence) showing an association between hypothermia and respiratory disease. One large randomized controlled trial 79 (low-quality evidence, downgraded for imprecision and risk of bias) found a reduction in pulmonary hemorrhage associated with improved admission temperature (OR, 0.57; 95% CI, 0.35-0.94).…”

Section: Consensus On Sciencementioning

confidence: 99%

“…Eight observational studies (very-low-quality evidence) have shown an improvement in respiratory outcomes after improved admission temperature maintenance. 44,49,51,63,72,84,93,95 Two of these have shown a decrease in respiratory support with improved temperature maintenance. 93,96 Two observational studies (very-low-quality evidence, downgraded for indirectness and imprecision) did not show any association.…”

Section: Consensus On Sciencementioning

confidence: 99%

“…44,49,51,63,72,84,93,95 Two of these have shown a decrease in respiratory support with improved temperature maintenance. 93,96 Two observational studies (very-low-quality evidence, downgraded for indirectness and imprecision) did not show any association. 43,60 For the serious outcome of hypoglycemia, there were seven observational studies (very-low-quality, downgraded for risk of bias and indirectness) showing a significant association between hypothermia (less than 36°C) and hypoglycemia.…”

Section: Consensus On Sciencementioning

confidence: 99%

“…This PICO question was intended to identify the strategies and techniques that might be most effective. For the critical outcome of hypothermia (temperature less than 36.0°C) at admission, we identified verylow-quality evidence (downgraded for serious risk of bias) from 4 observational studies 93,95,96,110 enrolling 9334 patients of less than 35 weeks of gestation showing benefit from using a combination of interventions (ie, environmental temperature 23°C to 25°C plus plastic wrap without drying plus cap plus thermal mattress plus radiant warmer; OR, 0.40; 95% CI, 0.35-0.46).…”

Section: Introductionmentioning

confidence: 99%

See 2 more Smart Citations

Part 7: Neonatal Resuscitation

Perlman¹,

Wyllie²,

Kattwinkel³

et al. 2015

Pediatrics

237

291

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Interventions to prevent hypothermia at birth in preterm and/or low birth weight infants

McCall

Alderdice

Halliday

et al. 2018

Cochrane Database of Systematic Reviews

260

211

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Evidence of moderate quality shows that use of plastic wraps or bags compared with routine care led to higher temperatures on admission to NICUs with less hypothermia, particularly for extremely preterm infants. Thermal mattresses and SSC also reduced hypothermia risk when compared with routine care, but findings are based on two or fewer small studies. Caution must be taken to avoid iatrogenic hyperthermia, particularly when multiple interventions are used simultaneously. Limited evidence suggests benefit and no evidence of harm for most short-term morbidity outcomes known to be associated with hypothermia, including major brain injury, bronchopulmonary dysplasia, retinopathy of prematurity, necrotising enterocolitis, and nosocomial infection. Many observational studies have shown increased mortality among preterm hypothermic infants compared with those who maintain normothermia, yet evidence is insufficient to suggest that these interventions reduce risk of in-hospital mortality across all comparison groups. Hypothermia may be a marker for illness and poorer outcomes by association rather than by causality. Limitations of this review include small numbers of identified studies; small sample sizes; and variations in methods and definitions used for hypothermia, hyperthermia, normothermia, routine care, and morbidity, along with lack of power to detect effects on morbidity and mortality across most comparison groups. Future studies should: be adequately powered to detect rarer outcomes; apply standardised morbidity definitions; focus on longer-term outcomes, particularly neurodevelopmental outcomes.

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Improving Delivery Room Management for Very Preterm Infants

Cited by 81 publications

References 35 publications

Implementation Methods for Delivery Room Management: A Quality Improvement Comparison Study

Implementation Methods for Delivery Room Management: A Quality Improvement Comparison Study

Part 7: Neonatal Resuscitation

Interventions to prevent hypothermia at birth in preterm and/or low birth weight infants

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