Dr Amy Keir, Dr Bronwyn Turner
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.