Baby It's Cold Outside

Purpose for the program: Evidence shows that cold stress and hypothermia contribute to neonatal morbidity and mortality. Newborn infants are at risk of heat loss, and current practices following their birth contribute to cold stress and hypothermia. In traditional practice, the operating room temperatures are established at the comfort level of the operating room staff, which is clothed in layers of scrubs and sterile gowns. Infants were transported to Mother Baby or the NICU wrapped in blankets, with no additional heat source. The initial bath was frequently performed within 30 minutes of birth. As part of our Perinatal Safety Team, we initiated a Project Team to look at our practices and outcomes and implement initiatives to decrease cold stress and hypothermia in our newborn population.

Proposed change: Strategies to reduce cold stress and hypothermia were examined and a plan was developed. Medical staff education, including recommendations from professional organizations and journals, was provided at Obstetrical and Pediatric Medical staff department meetings. Nursing education was provided via frequent presentations on all shifts in Labor and Delivery, NICU and on Mother Baby. The team collaborated with the engineering department to set and control temperatures in the Operating Room and in the NICU. Thermal gel mattresses and polyethylene wrap were obtained and implemented. Infants were transported to the NICU via a pre warmed transporter. Skin to skin policy was developed and implemented. A policy was developed to include delaying of the first infant bath until the temperature was within normal range for a minimum of two sets of vital signs (30 minutes apart) and no sooner than one to two hours of life.

Implementation, outcomes and evaluation: Prior to implementation of our program, our study revealed that 17% of infants were cold stressed and 3% were hypothermic. Following implementation, the average admission temperature was 36.9^o C (36.2 – 37.6^o C) at 30 minutes of life and 36.9^o C (36.4 – 37.7^oC) at 60 minutes of life. The number of cold stressed newborns were reduced to 5% at 30 minutes of age, and 3% were cold stressed at 60 minutes. No infants were hypothermic.

Implications for nursing practice: Implications for nursing practice from this imitative are that multidisciplinary team work and implementation of evidence based strategies can be effective in reducing incidents of neonatal hypothermia and cold stress. Additional studies would be prudent to determine further initiatives to prevent hypothermia and associated morbidities in neonates.

Keywords: neonatal, hypothermia, cold stress