Does normothermia in the delivery room predict NICU admission normothermia?

Abstract

Background

Normothermia during the first hour of life improves neonatal outcomes. Temperature is routinely assessed on admission to NICU, but the optimal time and method of assessing temperature after birth is not known.

Aim

Determine whether diagnosis and treatment of hypothermia in the Delivery Room/Operating Room (DR/OR) decreases NICU admission hypothermia. We hypothesized that infants’ post-stabilization temperature in the DR predicts NICU admission temperature, and that axillary temperatures correlate adequately with rectal measurements.

Methods

Newborn axillary temperatures were obtained in the DR/OR from March 2020–September 2021. Medical teams were instructed to perform standard interventions based on the unit's “hypothermia prevention bundle” and to achieve and document normothermia before departure from the DR/OR if possible. Axillary and rectal temperatures were obtained on admission to the NICU within 1 h of birth (n = 445, including 331 with DR/OR measurements).

Results

DR/OR axillary temperature moderately correlated with NICU admission axillary temperature (Pearson coefficient 0.40, p < 00.0001). After adjusting for delivery mode, respiratory support, gestational age, and time between measurements, DR/OR axillary temperature remained significantly associated with NICU admission temperature (p < 0.0001). Axillary temperatures were, on average, 0.13 ± 0.35 °C lower than rectal measurements.

Conclusions

Our findings suggest that achievement of normothermia in the DR/OR immediately after initial resuscitation is feasible and may decrease NICU admission hypothermia. Quality improvement interventions to decrease NICU hypothermia should include assessment of temperature in the DR/OR. Axillary temperatures are good approximation of rectal temperatures, enabling repeated non-invasive measurements to facilitate normothermia in the DR/OR and on admission to NICU.