6900 Thermoregulation in extreme pre-terms in first 6 hours after birth

Objectives The skin temperature of a naked newborn falls by 0.3°C every minute and recent data has shown that in neonates weighing less than 1500g, every 1°C drop in admission temperature causes a 28% increase in mortality.¹ Extreme preterms are at a much higher risk of hypothermia and associated morbidity due to their lack of brown fat required for non-shivering thermogenesis. They tend to especially drop their temperatures when they are moved from the delivery room to the NICU and initial investigations are undertaken. It is therefore key to ensure a stable thermal-neutral environment during this period. The aim of this audit is to assess if normothermia is achieved in extreme preterm babies in the first 6 hours after birth. Methods We performed a retrospective audit on the initial core body temperature control of extreme preterms (less than 28 week gestation) admitted to the level 3 NICU in Southmead Hospital, Bristol. Body temperature was reviewed at admission, 2 hours, 4 hours, and 6 hours of age and compared against the ideal standard of 36.5°C- 37.0°C. We also reviewed blood glucose and reviewed the notes to create an events log of procedures done in the first 6 hours to potentially extrapolate any pattern to the events. The data was collated, analyzed and presented at our regional audit meeting with recommendations for improvements. A re-audit is planned early next year after implementation of some of the recommendations. Results A total of 20 babies over a period of 6 months were included in this audit. The gestational age ranged from 22+0 to 27+6 weeks. Only 15% of the group remained normothermic throughout the first 6 hours. 60% had at least one period of hypothermia and 35% had temperature swings between hypo- and hyperthermia and vice versa. Insertion of central lines, intubation, Xrays, and cranial ultrasounds were main procedures that occurred during this period. 60% of the babies were hypothermic at the time of and after line insertion and x-rays. 1 baby was hyperthermic during lines, x-rays and intubation. Conclusion The results of this audit proved that extreme preterm babies are most at risk of hypothermia during line insertion and imagin g, but achieving a stable thermal-neutral environment is possible. Introducing practices like using incubators or using plastic coverings to cover extremities during procedures could help to greatly reduce temperature swinging, but we need to be wary of over-compensation. Limitations surrounding data collection also reiterated the importance of education around thermoregulation and constantly reminding medical and nursing staff to document temperatures clearly. Reference Tarun S Singh, et al. Improvement in thermoregulation outcomes following the implementation of a thermoregulation bundle for preterm infants March 30 2022.