Prevention of Hypothermia at Delivery in Infants Born Preterm, at 28 to 34 Weeks Gestation, Through Implementation of a Clinical-Workflow Process

Background: According to the March of Dimes, 10% of infants born nationally in 2021 were born prematurely, at less than 37 weeks. In Utah, 1% of infants are born prematurely each year, between 28 and 34 weeks. Worldwide, hypothermia at delivery occurs at a rate of 30% to 90% among infants delivered prematurely. Thermoregulation procedures have been established to prevent hypothermia but are not used consistently in some labor-and-delivery units. Nonadherence to existing protocols appears to potentially contribute to an increased incidence of hypothermia in infants delivered <34 weeks gestation, especially with the initiation of newer, delayed cord-clamping protocols, which have gained popularity globally. Methods: Providers, registered nurses, and technicians at Intermountain Medical Center's newborn intensive care unit and labor-and-delivery unit were educated regarding the existing thermoregulation-after-delivery protocol and the newer delayed-cord-clamping-at-delivery guideline. A new workflow process supporting the thermoregulation-after-delivery protocol was developed and implemented specific to the use of the bowel bag with infants delivered less than 34 weeks gestation. Subsequent to the implementation, a review of resuscitation records was conducted to evaluate the use of and adherence to the re-education of the protocol, and results were compared to pre-education data to determine success. Results: Baseline hypothermia rates at delivery, revealed a decrease from the rate of 23% pre- implementation to 8% post-implementation. After implementation of the education and workflow change, the bowel bag was utilization increased from none used at delivery to 75% of infants delivered preterm, at 28 to 34 weeks gestation. Protocols involving use of the bowel bag at delivery were already in place for infants delivered at less than 28 weeks. Conclusion: There was a high level of engagement in the prevention of hypothermia and complications in infants born less than 34 weeks gestation. The gap in knowledge and lack of compliance with the thermoregulation-after-delivery protocol presented an ideal opportunity to improve practice in infants delivered at 28 to 24 weeks gestation.