Keeping very low birth weight babies warm

April 29, 2019

CLEVELAND -- Physician-researchers at the 2019 Pediatric Academic Societies Meeting in Baltimore presented their process of how from 2014 to 2017 they made their NICU a center of excellence for increasing the admission body temperature of their very low birth weight babies to greater than 36 degrees

In several years preceding 2014, the medical staff of the Neonatal Intensive Care Unit (NICU) at University Hospitals Rainbow Babies & Children's Hospital and UH MacDonald Women's Hospital in Cleveland faced the problem of having almost 24 percent of VLBW (Very Low Birth Weight <1500 gms) babies of having a temperature of less than 36 degrees at the time of NICU admission. VLBW neonates are vulnerable to cold stress, which is associated with increased morbidity and mortality. Temperatures less than 36 degrees C are defined as hypothermic for these fragile babies by the World Health Organization. UH began quality improvement initiatives in 2014 to improve the temperatures.

Four thousand babies are delivered annually at UH MacDonald Women's Hospital; 150 of them VLBW neonates. VLBW babies are transferred to the 82-bed Level IV NICU next door in UH Rainbow Babies & Children's Hospital.

The team's goal was to decrease the rate of NICU admission hypothermia for all inborn VLBW neonates from 24 percent to less than five percent in five years.

They met their goal through a model for improvement quality initiative, through a comprehensive Key Driver Diagram (KDD) and several cycles of Plan-Do-Study-Act (PDSAs). For example, they minimized heat loss in the delivery room, during resuscitation and transfer to the NICU, among other measures.

Their results: 97.5 percent reduction of hypothermia (temperature less than 36 degrees) over a period of four years, from 24 percent to 0.6 percent in the VLBW babies. Ongoing work continues at the hospitals to sustain these measures.
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The authors from UH Rainbow are Rebecca Walsh, MD, Ana Paula Duarte Ribeiro, MD, Melissa Grathwol, RNC-NIC BSN, under leadership of Monika Bhola, MD. They are also on the faculty of the Case Western Reserve University School of Medicine. Others authors on the poster are Kimberly Larson, MD from Children's Hospital Oakland, and Christopher Stryker, MD, from MidAtlantic Neonatology Associates, Goryeb Children's Hospital in Morristown, NJ , who were also part of this initiative during their neonatal fellowship at Rainbow Babies and Children's Hospital

About UH Rainbow Babies & Children's


UH Rainbow Babies & Children's offers the most expansive pediatric care network in Northeast Ohio, with more than 740,000 annual patient encounters at 131 service locations. The vast network includes nationally-ranked UH Rainbow Babies & Children's Hospital -- Cleveland's only full-service, freestanding children's hospital with a medical staff of more than 745 physicians and Northern Ohio's only Level I Pediatric Trauma Center - along with a primary care network of more than 200 pediatric and family medicine providers at 83 offices, inpatient care, pediatric emergency services, urgent care centers, surgery centers, medical and surgical specialty clinics, and advanced newborn and maternal/fetal medicine services. Learn more at Rainbow.org.

About University Hospitals / Cleveland, Ohio

Founded in 1866, University Hospitals serves the needs of patients through an integrated network of 18 hospitals, more than 50 health centers and outpatient facilities, and 200 physician offices in 16 counties throughout northern Ohio. The system's flagship academic medical center, University Hospitals Cleveland Medical Center, located in Cleveland's University Circle, is affiliated with Case Western Reserve University School of Medicine. The main campus also includes University Hospitals Rainbow Babies & Children's Hospital, ranked among the top children's hospitals in the nation; University Hospitals MacDonald Women's Hospital, Ohio's only hospital for women; University Hospitals Harrington Heart & Vascular Institute, a high-volume national referral center for complex cardiovascular procedures; and University Hospitals Seidman Cancer Center, part of the NCI-designated Case Comprehensive Cancer Center. UH is home to some of the most prestigious clinical and research programs in the nation, including cancer, pediatrics, women's health, orthopedics, radiology, neuroscience, cardiology and cardiovascular surgery, digestive health, transplantation and urology. UH Cleveland Medical Center is perennially among the highest performers in national ranking surveys, including "America's Best Hospitals" from U.S. News & World Report. UH is also home to Harrington Discovery Institute at University Hospitals - part of The Harrington Project for Discovery & Development. UH is one of the largest employers in Northeast Ohio with 28,000 physicians and employees.

Advancing the Science of Health and the Art of Compassion is UH's vision for benefitting its patients into the future, and the organization's unwavering mission is To Heal. To Teach. To Discover. Follow UH on Facebook @UniversityHospitals and Twitter @UHhospitals. For more information, visit UHhospitals.org

About Case Western Reserve University School of Medicine

For more information about Case Western Reserve University School of Medicine, please visit: case.edu/medicine.

University Hospitals Cleveland Medical Center

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