P2.269: A Texas Statewide Perinatal Quality Collaborative Initiative to Improve Newborn Admission Temperature: Findings in Neonatal Intensive Care Unit Admissions

Purpose/Objectives: Hypothermia and hyperthermia are common in neonatal intensive care units (NICU) and contribute to infant morbidity and mortality. The statewide Newborn Admission Temperature (NAT) initiative aimed to decrease hypothermia and hyperthermia incidence in Texas newborns by supporting hospitals to implement evidence-based thermoregulation guidelines and to assess for disparities by maternal race and ethnicity.

Design/Methods: From July 2021 to September 2023, 122 NICUs submitted quarterly data to track incidence of hypothermia ( < 36°C) and hyperthermia (≥37.5°C) at admission. At project midpoint, thermoregulation guidelines were shared with hospitals. To estimate disparities in outcomes, analyses were limited to records with maternal race and ethnicity data. Baseline estimates (pre-guidelines release) included 92 NICUs (21,286 admissions). Longitudinal analysis included 24 hospitals that consistently submitted data.

Results: Baseline NICU hypothermia incidence was 3.0% (95% CI: 1.7, 4.3), and 50% higher for newborns of Non-Hispanic (NH) Black mothers compared to newborns of NH White mothers (4.6% vs. 2.9%, p< 0.001). Over the 4 follow-up quarters (post-guidelines release) there was a 19% per quarter decrease in hypothermia overall (p < 0.05); newborns of NH Black mothers had an estimated 22% per quarter decrease (p < 0.05) and newborns of NH White mothers had an estimated 28% per quarter decrease (p < 0.05).

Conclusion/Discussion: The finding of decreased hypothermia incidence highlights the potential of statewide initiatives for improvement in settings caring for the most vulnerable newborns. Based on the disparities identified in this study, future initiatives should assess for disparities to guide implementation and to assess whether improvements in outcomes are reaching all populations.