Neonatal Hypothermia During Transport, a MedSTAR Kids Experience
Amy Keir / Bronwyn Turner
General Paediatrician and advanced trainee Paediatric Emergency Medicine (RACP) and advanced trainee Paediatric Intensive Care (CICM). MedSTAR Kids (SAAS retrieval service) Fellow 2017. Currently working as an Emergency Registrar at Middlemore Hospital in Auckland, New Zealand
Neonatal hypothermia is a known risk factor for poorer outcomes in low birth weight infants and maintaining an appropriate temperature in the transport environment can be challenging. A previous audit at MedSTAR Kids (2013 – 2014), the paediatric/neonatal retrieval service of South Australia, showed low birth weight infants were experiencing mid-retrieval hypothermia with 64% (57/89) of neonates had an episode of hypothermia during transport (SOP temperature 36.4 – 37.2 degrees Celsius). This lead to a change in the standard baseline neonatal transport cot temperature from 32 to 35 degrees Celsius.
A follow up audit (2015 – 2016) was conducted to determine the impact of the transport cot baseline temperature change. The standard operating procedure target temperature range (SOP) is 36.4 – 37.2 while KPI is 36.0 - 37.5 degrees Celsius. 172 neonates < 2500g were transported in the 12-month period in the neonatal transport cot. Mean weight was 1850g with 35 neonates < 1500g and mean transport time was 64 minutes.
89% (148/167) neonates were within the KPI for all recorded temperatures, with 5 patients having no temperature data recorded in the database. When the initial (on arrival of the MSK team) temperature is excluded, 9 were below KPI limits (5%), 2 (2%) were above KPI limits and 2 (2%) were above and below KPI limits for one or more recorded temperatures. Using SOP, 64 patients were outside SOP limits (38%). When the on arrival temperature was excluded: 30 were below SOP limits (18%), 11 were above SOP temperature (6.5%) and 3 had temperatures that were both above and below SOP (2%).
Increasing the baseline temperature of the neonatal transport cot from 32 to 35 degrees has reduced the incidence of neonatal hypothermia during transport at MedSTAR Kids.