Use of chemical warming packs during delivery room resuscitation is associated with decreased rates of XXXX in very low-birth-weight neonates.

@entity5394 @entity221 @entity2332 @entity272
BACKGROUND: : @entity2332 is an independent contributor to neonatal mortality. All very low-birth-weight (VLBW) newborns have the potential to undergo cold stress or @entity2332 during delivery room stabilization. Thus, clinicians aiming to maintain normothermia in VLBW neonates are compelled to use multiple adjuncts of unknown efficacy or safety. OBJECTIVE: : To evaluate the effectiveness of thermoregulation procedures in maintaining normothermia during delivery room resuscitation and to assess the impact of an unanticipated change in equipment at our institution on the admission temperatures of VLBW newborns. DESIGN/METHODS: : Institutional review board-approved, retrospective analysis of quality assurance data submitted to the Vermont-Oxford Network (VON) for 24 consecutive months starting January 2006. We compared the rate of @entity2332 (admission temperature < 36.5  C) in our NICU during 2006 with the aggregate rates reported by VON. We then compared the rates of @entity2332 and mean admission temperatures in our NICU during period 1 (when chemical warming packs were used routinely, in addition to plastic wrapping and warm blankets) and @entity5394 (after packs were discontinued owing to an incident of focal @entity272 ). RESULTS: : In 2006, 42% of VLBW babies in our NICU had an admission temperature of less than 36.5  C compared with the VON rate of 61% (interquartile range 48%, 76%). During period 1, 39% of 183 VLBW neonates were hypothermic compared with 68% of 103 during @entity5394 (P < .001). Mean admission temperatures during periods 1 and 2 were 36.5  C and 36.1  C, respectively (P < .001). A control chart showed the shift in temperatures occurring as @entity5394 began. No change in practice other than discontinuation of the warming packs was instituted during @entity5394 . The incidence of temperatures greater than 38  C ( @entity221 ) was 1.6% during period 1 and 1.0% during @entity5394 . CONCLUSIONS: : The results associated with this isolated change in practice at our institution suggest that chemical warming packs were a useful adjunct in achieving above-average rates of normothermia during delivery room resuscitation of VLBW newborns. Their potential adverse effects should be weighed against the increased risk of mortality associated with @entity2332 in this population.
