Aims ILCOR Consensus Guidelines 2010 recommend that infants born at <28 weeks gestation (w) be delivered in ambient temperatures of ≥26oC and stabilised in a polyethylene bag/wrap under a radiant heater. The bag/wrap should be removed only after admission temperature has been checked. Admission temperatures (AT) <36.5oC are associated with increased mortality. We explored our current clinical practice to determine i) whether we comply with ILCOR recommendations, ii) whether our practice is adequate in achieving normothermia in infants admitted to NICU and iii) which factors contribute to hypothermia in preterm infants.
Methods We conducted a five month prospective audit of AT of all inborn infants <32w admitted to our tertiary NICU. FilacTM 3000 EZ digital thermometers were used to assess infants’ axillary temperatures.
Results We analysed 36 infants: mean (SD) birthweight 1085(358)g, gestational age 28(2)w. Mean maternal temperature was 36.8(0.5)oC but <36.5oC in 33% of mothers. All infants were stabilised on a resuscitaire under a radiant heater. Mean delivery room temperature (DRT) was 24.7(1.4)oC; ≥26oC in 9% and <24oC in 30%. Infants born in the operating room had a significantly lower mean AT than infants born in labour ward (p = 0.03). Mean infant temperature on the resuscitaire following stabilisation (RT) was 36.8(0.5)oC but <36.5oC in 19% of infants. Of the 19%, mean RT was 36.1oC (range ‘unrecordable’–36.3oC) and only two infants had a temperature >36.5oC within 1 h of admission. Regression analysis showed a strong association (48%) between RT and AT. Mean transport cot temperature was 36.9(0.5)oC. Mean AT was 36.8(0.7)oC; <36.5oC in 36%, >37.5oC in 14%. All infants <28w (n = 12) and 42% of infants ≥28w were stabilised in a polyethylene wrap. The mean AT was 36.9(0.7)oC for those stabilised in wraps (one unrecordable, 32% hypothermic at <36.5oC) and 36.5(0.6)oC for those not stabilised in wraps. In 41% of cases the wrap was removed before checking the AT.
Conclusions These data suggest that several factors affect AT, particularly DRT and RT. To comply fully with ILCOR guidelines certain aspects of clinical practice need to be improved including increasing DRT >26oC and keeping infants in wraps until AT is checked. A multidisciplinary approach is needed to improve temperature maintenance in the first minutes of life.