O3299: Admission temperature to Neonatal ICU after active Therapeutic Hypothermia on transport

Purpose/Objectives: For neonates receiving therapeutic hypothermia to abate sequelae following an acute hypoxic event, overcooling can lead to adverse complications, such as exacerbation of brain injury and pulmonary hypertension and fat necrosis. US News & World Report set a benchmark of < 10% of infants actively cooled on transport having admission temperatures < 33⁰C. Data from 2021 revealed a 21% rate of overcooled infants brought to Johns Hopkins (Fig 1a). In response, Maryland Regional Neonatal Transport Program a jointly operated program between the Johns Hopkins Children’s Center and University of Maryland Medical System, implemented a 5-step bundle QI initiative to address this issue on the Johns Hopkins site.

Design/Methods: The goal of this QI initiative is to meet and maintain the USNWR benchmark. In July 2022 the Hopkins branch of MRNTP implemented a process change by developing a 5- step bundle which included: 1) automated data collection and Microsoft form data capture; 2) process map development; 3) standardized use of rectal temperatures upon NICU admission; 4) adjusted cooling start time; and 5) updated policies. We hypothesized that this effort would better clarify cooling start time, standardize the use of rectal temperature upon admission to the NICU, and decrease the incidence of admission temperature falling outside the USNWR targeted parameters for infants actively cooled during interhospital transport.
To examine the effects of implementing this QI intervention, we performed a retrospective chart review of all neonates actively cooled on transport by our team 16 months pre- and 18 months post-intervention and compared admission temperatures. Data was analyzed with non-parametric and chi-squared testing, as appropriate.

Results: The bundle was initiated in July 2022. Sixty-six neonates were transported with active cooling during the study period: 24 (36.4%) pre-intervention and 42 (63.6%) post-intervention (Table). Birth weights and gestational ages were similar between groups, as was their median (IQR) admission temperature; however, the Sarnat scores were different between the pre- and post-intervention cohorts (p=0.008). While 29.2% (7/24) of the pre-intervention cohort had below-target admission temperatures after active cooling on transport, none of the post- intervention neonates had admission temperatures < 33°C (Figure 1d). The intervention most closely associated with improvement was elimination of use of axillary temperature on admission (Figure 1b). Although a higher proportion of post- vs. pre- intervention neonates had admission temperatures within goal, this was not statistically significant (78.6% vs. 58.3%, p=0.08) (Fig 1c).

Conclusion/Discussion: While data collection is ongoing, at present we have noted an important improvement with the standardized use of rectal temperature upon admission, specifically a decrease from 29% to 0 in incidence of overcooling.