P3.265: Improving Regional Newborn Transport Thermoregulation

Background: Preterm infants are at high risk for morbidity and mortality from poor thermoregulation due to decreased brown adipose stores and a high surface-area-to-body-mass ratio. The extent of neonatal hypothermia is directly correlated to short and long-term adverse effects. 39.8% to 68.2% of neonates are hypothermic on admission to the NICU. Patients born outside the hospital or at community hospitals who require transport via ambulance are at increased risk of hypothermia. Preterm infants managed by a trained Neonatal Transport Team under standardized protocols are suspected to have improved physiological stability and thermoregulation in comparison to those managed by standard EMS transportation. This study aims to analyze neonatal temperatures during transport managed by a dedicated Neonatal Transport Team prior to admission to a large regional tertiary care NICU.

Methods: Using data from the Statewide Perinatal Database System's High-Risk NICU Module, we analyzed newborn transports to a regional perinatal center for Northeastern New York State within the first 24 hours of life from January 1, 2014, to December 31, 2023. Data was manually extracted from the infants’ electronic records. Our initial dataset included 1,703 newborn transports. 261 were excluded as transport temperature was not found. 232 cases were removed due to neonatal hypoxic-ischemic encephalopathy treated with therapeutic hypothermia during transport.

Results: A total of 1,210 infants were ultimately included. 939 infants (77.6%) maintained an acceptable temperature during transport, with an average temperature of 37.0°C and a standard deviation of 0.5°C. 142 infants (11.7%) were hypothermic, and 129 infants (10.7%) were hyperthermic. When stratified by age, infants under 30 weeks had average transport temperatures that were statistically significantly different from those born at 30 weeks or more (36.8°C vs. 37.0°C, p-value 0.002). This is not clinically significant however, as both groups maintained average temperatures that are considered euthermic. In comparison, neonates born at 22 or 23 weeks gestation had statistically and clinically significantly lower temperatures than those born at 30 weeks or more (35.6°C vs. 37.0°C, p-value < 0.001).

Conclusion: Dedicated neonatal transport teams have improved thermoregulation and physiologic stability in preterm infants compared to standard ground EMS. Our analysis has shown that this dedicated regional neonatal transport team over 9 years had consistent temperature management, with 77.6% in optimal range and only 11.7% considered hypothermic. Within our region, standard EMS does not have specialized equipment and procedures to support adequate thermoregulation of preterm infants. Thermal mattresses and plastic wrap are inexpensive solutions that could be implemented by standard EMS to prevent hypothermia. Our goal is to improve neonatal transport thermoregulation and patient outcomes through partnership with EMS to improve equipment and education in the care of the newly born.