Traditional Poster Round
Background: Preterm infants have a large surface area to body ratio and are at greater risk of becoming hypothermic than their full term counterparts. For every one degree below 36.5c the risk of mortality for these babies increases by 28% .
Problem: Of the last 40 babies born at our unit and admitted to NICU the admission temperature has been outside of normal range in 33% of babies (13 babies). Hypothermia appears to be a larger problem than hyperthermia, with low temperature accounting for 7 of the 13 babies with suboptimal admission temperature.
Role of Simulation: Following on from the above audit we wanted to review real-life practices around thermoregulation at preterm deliveries. Whilst this would be difficult to do without recording live resuscitations, we felt simulation sessions would provide an appropriate avenue to explore staff members approaches to thermoregulation. Although thermoregulation principles of delivery into a plastic bag and placing under a radiant heat source is well known by staff on the unit, there can be several logistical issues to ensure this is accurate applied in real-life.
A simulation scenario was written regarding the spontaneous vaginal delivery of preterm twins. Prior to the simulation session it was explained to participants that the scenario would be recorded via GoPro in order to take various measurements from the manikin, but the participants were not informed the purpose of the recording was to monitor temperature regulation practices. The simulation was recorded and the video footage analysed afterward, quantifying the percentage body surface area was exposed and the minute-to-minute variation in exposure over the course of the stabilisation. A standardised total body surface area map was used to evaluate percentage body area exposed in each scenario for each baby.
Results: The simulation sessions illustrated that in all cases the plastic bag into which the infant was placed was not always adequately covering the baby, and, therefore, would not be creating a humid environment for the baby under the radiant heater.
There was large variation in what percentage body surface area was exposed – between 10 – 80%. In the scenario where 80% of the baby was exposed, the increase from 50% to 80% at 11 minutes of age occurred when the towel was placed over the baby, obscuring the radiant heat source. This occurred in three of the six scenarios. By placing the towel over the baby the radiant heat source is blocked and the plastic bag then creates a cold, wet environment – causing cooling of the baby’s core temperature.
In all cases, temperature was first checked after 10 minutes of age (between 12 – 19 minute of age for the three babies where the team checked the temperature. In three cases, no temperature was checked).
- Making thermoregulation the focus in future simulation delivery scenarios.
- Increased education sessions on NICU on thermoregulation.
- Using this data to encourage keeping the maximum body surface area of the baby within the plastic bag where possible, and having more conscious attention paid to ensuring this is done.
- Highlights the need for early and then continued, regular temperature checks during stabilisation/resuscitation processes.