It's Freezing Out There… Keeping a Tight Wrap on Late Preterm Infant Hypothermia

Purpose for the program:

Infants born between 34 to 36 ^6/7 weeks gestation are referred to as Late Preterm Infants (LPI’s).  This growing group of unique infants presents a significant challenge for the Maternal-Child nurse.  LPI’s often present to the Newborn Nursery with a multitude of issues.  Hypothermia is one of a series of problems that is encountered by the LPI.  Hypothermia poses a significant problem because cold stress can lead to numerous complications in the Late Preterm Infant.  Difficulty effectively generating heat from brown fat places LPI’s at an increased risk of developing hypothermia.   Subsequently, LPI’s frequently present to the Newborn Nursery with marked hypothermia.  In an effort to understand the extent of the problem, nursing staff at a large urban hospital conducted a chart review of LPI’s.  Data revealed that 80% of the LPI population had experienced at least one episode of hypothermia.  Based upon these findings, nursing staff began to question their current infant care practices.  In response to the problem, a task force of Maternal-Child nurses was developed and a new Late Preterm Infant Thermoregulation Guideline was created and implemented on the Maternal-Child unit.

Proposed change:

Strategies developed by nursing staff to support infant thermoregulation include early identification of all LPI’s.  Visual cues to remind nursing staff that an infant is Late Preterm include the use of a yellow report sheet for professional exchange report, a yellow crib card, a yellow infant cap, and a yellow LPI education sheet for parents.  The use of the color yellow allows the LPI to be “spot-lighted” throughout their entire hospital stay.  LPI’s are double wrapped and wear an infant cap at all times.  Vital sign assessment is performed every four hours and modifications are made to the infant’s environment based upon assessment results.

Implementation, outcomes and evaluation:

Data collection of infant hypothermia findings occur with each LPI delivery.  Incidence rate results are disseminated to staff members on a monthly basis and unit goals and performance evaluations are linked with LPI hypothermia rates.  The implementation of the newly designed Late Preterm Infant Thermoregulation Guideline has yielded significant results.  Outcomes include the delivery of improved infant care practices as well as a reduction in the incidence rate of hypothermia from 80% to 5% in less than a year.    

Implications for nursing practice:

Implications for nursing practice include improved delivery of Late Preterm Infant hypothermia care practices.

Keywords:

Late Preterm Infant, Hypothermia