{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,23]],"date-time":"2026-09-23T16:16:23Z","timestamp":1790180183221,"version":"4.1.0"},"reference-count":46,"publisher":"American Academy of Pediatrics (AAP)","issue":"11","content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":[],"published-print":{"date-parts":[[2024,11,1]]},"abstract":"\n BACKGROUND<\/jats:title>\n NICU admission for hypothermia is a problem worldwide, with associated morbidity, mortality, and financial costs. Many interventions have been studied for smaller infants, but there has been little focus on infants born \u226534 weeks\u2019 gestational age (GA), though most deliveries occur at this gestation. Our primary aim was to improve the proportion of infants \u226534 weeks\u2019 GA with normal NICU admission temperature. Secondary outcomes included improvement of the proportion of normal first temperature in all infants \u226534 weeks\u2019 GA, independent of NICU admission, and improvement of predefined outcome measures.<\/jats:p>\n <\/jats:sec>\n \n METHODS<\/jats:title>\n We completed a root cause analysis, using fishbone and process mapping to determine what factors were contributing to hypothermia. A series of changes were trialed using plan-do-study-act cycles to develop a standard operating procedure, covering both vaginal and cesarean section births. Outcome measures were analyzed using a P-chart as well as traditional statistical tests.<\/jats:p>\n <\/jats:sec>\n \n RESULTS<\/jats:title>\n We successfully increased the proportion of infants \u226534 weeks\u2019 GA with normothermia on NICU admission from 62% to 80% without increasing hyperthermia. In addition, the interventions improved the proportion of delivery room normothermia in all infants born \u226534 weeks\u2019 GA and were associated with a decreased need for intravenous therapy for hypoglycemia and the incidence of metabolic acidosis.<\/jats:p>\n <\/jats:sec>\n \n CONCLUSIONS<\/jats:title>\n This quality improvement initiative was successful at improving our institution\u2019s rates of normal infant temperature. The methodology used can be applied to other similar centers to improve this common problem.<\/jats:p>\n <\/jats:sec>","DOI":"10.1542\/hpeds.2023-007683","type":"journal-article","created":{"date-parts":[[2024,10,28]],"date-time":"2024-10-28T08:06:19Z","timestamp":1730102779000},"page":"890-898","source":"Crossref","is-referenced-by-count":1,"title":["Improving Admission Temperature in Infants \u226534 Weeks\u2019 Gestation: A Quality Improvement Initiative"],"prefix":"10.1542","volume":"14","author":[{"given":"Sarah Linda","family":"Lawrence","sequence":"first","affiliation":[{"name":"aThe Ottawa Hospital, General Campus, Ottawa Ontario, Canada"},{"name":"bChildren's Hospital of Eastern Ontario Research Institute, Ottawa, Ontario, Canada"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Laura","family":"Nguyen","sequence":"additional","affiliation":[{"name":"cFaculty of Medicine, University of Ottawa, Ottawa, Ontario, Canada"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ewa","family":"Sucha","sequence":"additional","affiliation":[{"name":"bChildren's Hospital of Eastern Ontario Research Institute, Ottawa, Ontario, Canada"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Brigitte","family":"Lemyre","sequence":"additional","affiliation":[{"name":"aThe Ottawa Hospital, General Campus, Ottawa Ontario, Canada"},{"name":"bChildren's Hospital of Eastern Ontario Research Institute, Ottawa, Ontario, Canada"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Nicholas","family":"Mitsakakis","sequence":"additional","affiliation":[{"name":"bChildren's Hospital of Eastern Ontario Research Institute, Ottawa, Ontario, Canada"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"417","published-online":{"date-parts":[[2024,10,28]]},"reference":[{"key":"2024110813305042600_B1","volume-title":"Thermal protection of the newborn: a practical guide","author":"World Health Organization","year":"1997"},{"issue":"1","key":"2024110813305042600_B2","doi-asserted-by":"crossref","first-page":"F47","DOI":"10.1136\/fn.76.1.F47","article-title":"Temperature control in very low birthweight infants during first five days of life","volume":"76","author":"Lyon","year":"1997","journal-title":"Arch Dis Child Fetal Neonatal Ed"},{"key":"2024110813305042600_B3","doi-asserted-by":"crossref","first-page":"531","DOI":"10.1097\/00000542-196507000-00017","article-title":"Thermal homeostasis in the fetus and newborn","volume":"26","author":"Adamson","year":"1965","journal-title":"Anesthesiology"},{"issue":"4","key":"2024110813305042600_B4","doi-asserted-by":"crossref","first-page":"504","DOI":"10.1542\/peds.49.4.504","article-title":"Newborn temperature and calculated heat loss in the delivery room","volume":"49","author":"Dahm","year":"1972","journal-title":"Pediatrics"},{"issue":"6","key":"2024110813305042600_B5","doi-asserted-by":"crossref","first-page":"360","DOI":"10.1272\/jnms.71.360","article-title":"Fetal and neonatal thermoregulation","volume":"71","author":"Asakura","year":"2004","journal-title":"J Nippon Med Sch"},{"issue":"4","key":"2024110813305042600_B6","first-page":"484","article-title":"Forced-air warming and continuous core temperature monitoring with zero-heat-flux thermometry during cesarean section: a retrospective observational cohort study","volume":"72","author":"Marin","year":"2022","journal-title":"Braz J Anesthesiol"},{"issue":"7","key":"2024110813305042600_B7","doi-asserted-by":"crossref","first-page":"436","DOI":"10.1097\/OGX.0b013e3182605ccd","article-title":"Maintaining perioperative normothermia in the patient undergoing cesarean delivery","volume":"67","author":"Carpenter","year":"2012","journal-title":"Obstet Gynecol Surv"},{"issue":"7","key":"2024110813305042600_B8","doi-asserted-by":"crossref","first-page":"650","DOI":"10.1001\/archpediatrics.2010.103","article-title":"Risk of mortality associated with neonatal hypothermia in Southern Nepal","volume":"164","author":"Mullany","year":"2010","journal-title":"Arch Pediatr Adolesc Med"},{"key":"2024110813305042600_B9","doi-asserted-by":"crossref","first-page":"81","DOI":"10.1016\/j.resuscitation.2022.09.014","article-title":"Maintaining normal temperature immediately after birth in late preterm and term infants: a systematic review and meta-analysis","volume":"180","author":"Ramaswamy","year":"2022","journal-title":"Resuscitation"},{"key":"2024110813305042600_B10","doi-asserted-by":"crossref","first-page":"S204","DOI":"10.1161\/CIR.0000000000000276","article-title":"Part 7: neonatal resuscitation: 2015 International Consensus on Cardiopulmonary Resuscitation and Emergency Cardiovascular Care Science With Treatment Recommendations","volume":"132","author":"Perlman","year":"2015","journal-title":"Circulation"},{"issue":"9","key":"2024110813305042600_B11","first-page":"1367","article-title":"Hypothermia in Iranian newborns. Incidence, risk factors and related complications","volume":"26","author":"Zayeri","year":"2005","journal-title":"Saudi Med J"},{"key":"2024110813305042600_B12","doi-asserted-by":"crossref","first-page":"24","DOI":"10.1186\/1741-7015-11-24","article-title":"The global burden of neonatal hypothermia: systematic review of a major challenge for newborn survival","volume":"11","author":"Lunze","year":"2013","journal-title":"BMC Med"},{"issue":"9\u201310","key":"2024110813305042600_B13","doi-asserted-by":"crossref","first-page":"604","DOI":"10.2298\/SARH1010604L","article-title":"[Transitory hypothermia as early prognostic factor in term newborns with intrauterine growth retardation]","volume":"138","author":"Lazi\u0107-Mitrovi\u0107","year":"2010","journal-title":"Srp Arh Celok Lek"},{"issue":"8","key":"2024110813305042600_B14","doi-asserted-by":"crossref","first-page":"35","DOI":"10.1891\/0730-0832.20.8.35","article-title":"Recognizing and understanding the cold-stressed term infant","volume":"20","author":"Hackman","year":"2001","journal-title":"Neonatal Netw"},{"issue":"3","key":"2024110813305042600_B15","doi-asserted-by":"crossref","first-page":"270","DOI":"10.1542\/hpeds.2020-003269","article-title":"Quality improvement approach to reducing admission hypothermia among preterm and term infants","volume":"11","author":"Sprecher","year":"2021","journal-title":"Hosp Pediatr"},{"key":"2024110813305042600_B16","doi-asserted-by":"crossref","first-page":"S49","DOI":"10.1038\/jp.2010.177","article-title":"Hypothermia in very low birth weight infants: distribution, risk factors and outcomes","volume":"31","author":"Miller","year":"2011","journal-title":"J Perinatol"},{"issue":"1","key":"2024110813305042600_B17","doi-asserted-by":"crossref","first-page":"24","DOI":"10.1053\/j.semperi.2006.01.014","article-title":"Cold stress and hypoglycemia in the late preterm (\u201cnear-term\") infant: impact on nursery of admission","volume":"30","author":"Laptook","year":"2006","journal-title":"Semin Perinatol"},{"issue":"3","key":"2024110813305042600_B18","doi-asserted-by":"crossref","first-page":"e643","DOI":"10.1542\/peds.2006-0943","article-title":"Admission temperature of low birth weight infants: predictors and associated morbidities","volume":"119","author":"Laptook","year":"2007","journal-title":"Pediatrics"},{"key":"2024110813305042600_B19","unstructured":"Vermont Oxford Network. NICU by the numbers. Available at: https:\/\/public.vtoxford.org\/nicu-by-the-numbers\/despitedecreases-nearly-4-in-10-infants-are-cold-when-admitted-to-thenicu\/. Accessed August 19, 2024"},{"issue":"1","key":"2024110813305042600_B20","doi-asserted-by":"crossref","first-page":"447","DOI":"10.1186\/s12887-022-03512-x","article-title":"Factors associated with hypothermia within the first 6\u2009hours of life in infants born at \u226534\u00b0\u2009weeks' gestation: a multivariable analysis","volume":"22","author":"Nguyen","year":"2022","journal-title":"BMC Pediatr"},{"issue":"3","key":"2024110813305042600_B21","doi-asserted-by":"crossref","first-page":"214","DOI":"10.1097\/ANC.0000000000000787","article-title":"Neonatal intensive care unit admission temperatures of infants 1500 g or more: the cold truth","volume":"21","author":"Apanovitch","year":"2021","journal-title":"Adv Neonatal Care"},{"issue":"5","key":"2024110813305042600_B22","doi-asserted-by":"crossref","first-page":"235","DOI":"10.1055\/s-0043-118809","article-title":"Verhindert eine h\u00f6here Raumtemperatur im Erstversorgungsraum die Ausk\u00fchlung von Fr\u00fchgeborenen unter 1500\u2009g? [Does a higher ambient temperature in the delivery room prevent hypothermia in preterm infants <1500\u2009g?]","volume":"221","author":"Johannsen","year":"2017","journal-title":"Z Geburtshilfe Neonatol"},{"issue":"4","key":"2024110813305042600_B23","doi-asserted-by":"crossref","first-page":"264","DOI":"10.1038\/jp.2012.100","article-title":"Effect of delivery room temperature on the admission temperature of premature infants: a randomized controlled trial","volume":"33","author":"Jia","year":"2013","journal-title":"J Perinatol"},{"issue":"4","key":"2024110813305042600_B24","doi-asserted-by":"crossref","first-page":"505.e1","DOI":"10.1016\/j.ajog.2016.01.190","article-title":"The impact of ambient operating room temperature on neonatal and maternal hypothermia and associated morbidities: a randomized controlled trial","volume":"214","author":"Duryea","year":"2016","journal-title":"Am J Obstet Gynecol"},{"issue":"1","key":"2024110813305042600_B25","doi-asserted-by":"crossref","first-page":"655","DOI":"10.1186\/s12884-022-04983-7","article-title":"Duration of skin-to-skin care and rectal temperatures in late preterm and term infants","volume":"22","author":"Kardum","year":"2022","journal-title":"BMC Pregnancy Childbirth"},{"issue":"3","key":"2024110813305042600_B26","doi-asserted-by":"crossref","first-page":"186","DOI":"10.4236\/ojanes.2013.33043","article-title":"Maintaining neonatal normothermia during WHO recommended skin-to-skin contact in the setting of cesarean section under regional anesthesia","volume":"3","author":"Stirparo","year":"2013","journal-title":"OJAnes"},{"issue":"1","key":"2024110813305042600_B27","doi-asserted-by":"crossref","first-page":"68","DOI":"10.1097\/JPN.0000000000000384","article-title":"Effects of paternal skin-to-skin contact in newborns and fathers after cesarean delivery","volume":"33","author":"Huang","year":"2019","journal-title":"J Perinat Neonatal Nurs"},{"issue":"3","key":"2024110813305042600_B28","doi-asserted-by":"crossref","first-page":"e20171214","DOI":"10.1542\/peds.2017-1214","article-title":"Quality-improvement effort to reduce hypothermia among high-risk infants on a mother-infant unit","volume":"141","author":"Andrews","year":"2018","journal-title":"Pediatrics"},{"issue":"8","key":"2024110813305042600_B29","doi-asserted-by":"crossref","first-page":"843","DOI":"10.1016\/j.ijnurstu.2004.03.010","article-title":"The effect of wool versus cotton head covering and length of stay with the mother following delivery on infant temperature","volume":"41","author":"Lang","year":"2004","journal-title":"Int J Nurs Stud"},{"issue":"6","key":"2024110813305042600_B30","doi-asserted-by":"crossref","first-page":"e0156960","DOI":"10.1371\/journal.pone.0156960","article-title":"Efficacy and safety of plastic wrap for prevention of hypothermia after birth and during NICU in preterm infants: a systematic review and meta-analysis","volume":"11","author":"Li","year":"2016","journal-title":"PLoS One"},{"issue":"2","key":"2024110813305042600_B31","doi-asserted-by":"crossref","first-page":"262","DOI":"10.1016\/j.jpeds.2014.09.068","article-title":"Randomized trial of occlusive wrap for heat loss prevention in preterm infants","volume":"166","author":"Reilly","year":"2015","journal-title":"J Pediatr"},{"issue":"5","key":"2024110813305042600_B32","doi-asserted-by":"crossref","first-page":"304","DOI":"10.1038\/sj.jp.7211289","article-title":"Heat loss prevention for preterm infants in the delivery room","volume":"25","author":"Knobel","year":"2005","journal-title":"J Perinatol"},{"issue":"12","key":"2024110813305042600_B33","doi-asserted-by":"crossref","first-page":"780","DOI":"10.1038\/jp.2011.33","article-title":"Safety and efficacy of Trans-warmer mattress for preterm neonates: results of a randomized controlled trial","volume":"31","author":"Chawla","year":"2011","journal-title":"J Perinatol"},{"issue":"1","key":"2024110813305042600_B34","doi-asserted-by":"crossref","first-page":"34","DOI":"10.1097\/01.ANC.0000346094.28110.11","article-title":"Use of the heated gel mattress and its impact on admission temperature of very low birth-weight infants","volume":"9","author":"Almeida","year":"2009","journal-title":"Adv Neonatal Care"},{"issue":"1","key":"2024110813305042600_B35","doi-asserted-by":"crossref","first-page":"e135","DOI":"10.1542\/peds.2013-0279","article-title":"A randomized trial of exothermic mattresses for preterm newborns in polyethylene bags","volume":"132","author":"McCarthy","year":"2013","journal-title":"Pediatrics"},{"issue":"9","key":"2024110813305042600_B36","doi-asserted-by":"crossref","first-page":"e210775","DOI":"10.1001\/jamapediatrics.2021.0775","article-title":"Delivery room interventions for hypothermia in preterm neonates: a systematic review and network meta-analysis","volume":"175","author":"Abiramalatha","year":"2021","journal-title":"JAMA Pediatr"},{"issue":"4","key":"2024110813305042600_B37","doi-asserted-by":"crossref","first-page":"e1055-62","DOI":"10.1542\/peds.2013-2544","article-title":"Reducing hypothermia in preterm infants following delivery","volume":"133","author":"Russo","year":"2014","journal-title":"Pediatrics"},{"issue":"12","key":"2024110813305042600_B38","doi-asserted-by":"crossref","first-page":"1851","DOI":"10.1007\/s00431-020-03711-7","article-title":"The impact of a quality improvement project to reduce admission hypothermia on mortality and morbidity in very low birth weight infants","volume":"179","author":"Sharma","year":"2020","journal-title":"Eur J Pediatr"},{"issue":"7","key":"2024110813305042600_B39","doi-asserted-by":"crossref","first-page":"922","DOI":"10.1093\/intqhc\/mzx131","article-title":"A quality improvement project to reduce hypothermia in preterm infants on admission to the neonatal intensive care unit","volume":"29","author":"Yip","year":"2017","journal-title":"Int J Qual Health Care"},{"issue":"7","key":"2024110813305042600_B40","doi-asserted-by":"crossref","first-page":"1201","DOI":"10.1111\/jpc.15949","article-title":"Improvement in thermoregulation outcomes following the implementation of a thermoregulation bundle for preterm infants","volume":"58","author":"Singh","year":"2022","journal-title":"J Paediatr Child Health"},{"issue":"4","key":"2024110813305042600_B41","doi-asserted-by":"crossref","first-page":"368","DOI":"10.1016\/j.jped.2017.06.016","article-title":"Effectiveness of a measure program to prevent admission hypothermia in very low-birth weight preterm infants","volume":"94","author":"Caldas","year":"2018","journal-title":"J Pediatr (Rio J)"},{"issue":"3","key":"2024110813305042600_B42","doi-asserted-by":"crossref","first-page":"8","DOI":"10.7812\/TPP\/12-130","article-title":"Elimination of admission hypothermia in preterm very low-birth-weight infants by standardization of delivery room management","volume":"17","author":"Manani","year":"2013","journal-title":"Perm J"},{"issue":"4","key":"2024110813305042600_B43","doi-asserted-by":"crossref","first-page":"e1018","DOI":"10.1542\/peds.2013-0686","article-title":"Improving delivery room management for very preterm infants","volume":"132","author":"DeMauro","year":"2013","journal-title":"Pediatrics"},{"issue":"2","key":"2024110813305042600_B44","doi-asserted-by":"crossref","first-page":"e12286","DOI":"10.1111\/jspn.12286","article-title":"The effect of thermoregulation quality improvement initiatives on the admission temperature of premature\/very low birth-weight infants in neonatal intensive care units: a systematic review","volume":"25","author":"Donnellan","year":"2020","journal-title":"J Spec Pediatr Nurs"},{"issue":"6","key":"2024110813305042600_B45","doi-asserted-by":"crossref","first-page":"458","DOI":"10.1136\/qhc.12.6.458","article-title":"Statistical process control as a tool for research and healthcare improvement","volume":"12","author":"Benneyan","year":"2003","journal-title":"Qual Saf Health Care"},{"issue":"4","key":"2024110813305042600_B46","doi-asserted-by":"crossref","first-page":"435","DOI":"10.1136\/archdischild-2020-320123","article-title":"Bench-top comparison of thermometers used in newborn infants","volume":"106","author":"Dunne","year":"2021","journal-title":"Arch Dis Child Fetal Neonatal Ed"}],"container-title":["Hospital Pediatrics"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/publications.aap.org\/hospitalpediatrics\/article-pdf\/14\/11\/890\/1733664\/hpeds.2023-007683.pdf","content-type":"application\/pdf","content-version":"vor","intended-application":"syndication"},{"URL":"https:\/\/publications.aap.org\/hospitalpediatrics\/article-pdf\/14\/11\/890\/1733664\/hpeds.2023-007683.pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2024,11,8]],"date-time":"2024-11-08T13:31:15Z","timestamp":1731072675000},"score":1,"resource":{"primary":{"URL":"https:\/\/publications.aap.org\/hospitalpediatrics\/article\/14\/11\/890\/199720\/Improving-Admission-Temperature-in-Infants-34"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2024,10,28]]},"references-count":46,"journal-issue":{"issue":"11","published-online":{"date-parts":[[2024,10,28]]},"published-print":{"date-parts":[[2024,11,1]]}},"URL":"https:\/\/doi.org\/10.1542\/hpeds.2023-007683","relation":{},"ISSN":["2154-1663","2154-1671"],"issn-type":[{"value":"2154-1663","type":"print"},{"value":"2154-1671","type":"electronic"}],"subject":[],"published":{"date-parts":[[2024,10,28]]}}}