O3319: Prevention of Neonatal Hypothermia on Transport

Purpose/Objectives: Neonatal hypothermia upon admission to the neonatal intensive care unit (NICU) is associated with increased morbidity and mortality. Upon reviewing the data, the Lurie Children’s Transport Team observed an increase in the incidence of unintended neonatal hypothermia (admission temperature < 36.5°C) among transported neonates ( < 29 days of age) from 1.5% in fiscal year (FY) 2022 to 6.3% in FY 2023. To address this concerning trend, we convened a multidisciplinary group to identify the associated factors and develop interventions to reduce hypothermia. Our SMART Aim statement was to decrease unintended neonatal hypothermia to < 4% before end of FY24.

Design/Methods: A multidisciplinary group including members from the transport team and neonatal intensive care unit conducted a barriers assessment and current state analysis utilizing a fishbone diagram to identify factors contributing to neonatal hypothermia. All neonates less than 29 days of life that were transported to the Lurie Children’s Hospital were included in the analysis. Patients were excluded if they were greater than 29 days of age or undergoing therapeutic hypothermia treatment. Data was abstracted using the electronic health system’s (Epic) and then visualized and analyzed using Microsoft Power BI.
A multifactorial intervention was implemented to address neonatal hypothermia. The neonatal transport team protocol was revised to include specific guidance on the management of hypothermia. A comprehensive education and simulation-based training program was introduced during the transport team’s core education day. Real time data was displayed on the team’s huddle board and discussed during shift change huddles to support situational awareness and continuous quality improvement. Additionally, a servo regulated isolette was purchased and implemented in FY25 (Figure 1).

Results: Following the implementation of targeted quality improvement strategies, the incidence of unintended hypothermia decreased from 6.3% FY23 to 5.8% FY24 (Figure 2). Preliminary data for FY25 which incorporates the use of a new servo-controlled transport isolette (International Biomedical, Ltd.) indicate a further reduction to 3.8% .
However, an increase in neonatal hyperthermia (admission temperature >37.5C) was observed, rising to 7.2% in FY24.

Conclusion/Discussion: Through the application of quality improvement methodology, contributing factors to neonatal hypothermia were identified and addressed with protocol revision, education and new equipment. While we did not meet the goal by the intended timeline, in FY25 the incidence of neonatal hypothermia has decreased to 3.8% therefore meeting the goal of reducing hypothermia to below 4%. The trend will be maintained and improved through ongoing education, simulation practice of interventions, and continuous monitoring of data. A concurrent incidence of neonatal hyperthermia highlights the need for a balanced strategy. Our next steps will focus on identifying potential interventions to reduce hyperthermia recognizing the impact on morbidity.