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Network approach to thermoregulation and improvements in admission temperature
  1. S Seaton1,
  2. B Manktelow1,
  3. S Oddie2
  1. 1Department of Health Sciences, University of Leicester, Leicester, UK
  2. 2Bradford Neonatology, Bradford Teaching Hospitals, Bradford, UK

Abstract

Background Hypothermia at admission for neonatal intensive care is strongly associated with risk of death (OR 1.7)1. A Neonatal Network (Area A) identified this as a priority area for work in 2005 and developed a standard. Working collaboratively, they delivered training and regular updates across Area A units, which provide neonatal care for 40 000 births per year.

Aims To examine trends in temperature on admission (TOA) for neonatal care across Area A, and compare these with a comparable adjacent population.

Subjects All neonatal admissions 23–31 weeks gestation

Methods Data were collected as part of The Neonatal Survey. The authors compared Area A TOA to those in the adjacent Area B (70 000 births per year). Changes in proportions of infants reaching the Area A standard (≥36.5°C) were compared using χ2 test for trend, and changes in mean TOAs were investigated using linear and logistic regression.

Results Data on 5228 of 5299 admitted babies were analysed, of whom 1867 were within Area A. TOA improved in Area A, but not in all units. The proportion of TOAs above standard improved in both areas (Area A 50.1% in 2005, 74.1% in 2008 p<0.001; Area B 55.3% 2005, 62.5% 2008 p=0.001) but in 2008, Area A's differed from Area B's (p<0.05). Mean TOA also improved (p<0.001; figure 1). Mean Area A TOA was below that in Area B in 2005 (p=0.019), but exceeded those in Area B by 2008 (p<0.0001).

Abstract G176 Figure 1

Area A mean TOA 2005–2008.

Conclusion These data show that babies can be admitted with improved TOA even at the lowest gestations. Network led collaborative work across a whole population may improve outcomes faster than background trends.

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