Rationale Behind the Audit

Neonatal Thermoregulation Audit on the Special Baby Unit at Jinja Referral Hospital , Uganda March 2014

Objective: By 6 months, to have conducted 2 audits of temperature control in preterm babies with the aim of avoiding hypothermia in neonates’ pre and post teaching about kangaroo mother care and importance of thermoregulation in a neonate

Rationale behind the audit Growth and development of low birth weight and premature babies is highly dependent on good temperature control. The recommended optimal temperature range for a neonate is 36.5–37.5 °C. Temperature below 36.5 degrees is defined as hypothermia. Hypothermia in neonates results in poor growth and poor weight gain. This babies born with a low birth weight or born too soon (premature) are at risk of hypothermia secondary to several factors such as increase surface area, lack of brown fat, and iatrogenic causes such as wrapping in wet clothes or inadequate external thermoregulations e.g. lack of Kangaroo Mother Care or poor heat control in incubators.

In an otherwise well baby no longer requiring respiratory support, research have shown that Kangaroo Mother Care is the single most effective way of preventing hypothermia in low birth weight/premature babies

The aim of the audit is to review the temperatures of babies on the neonatal unit on a given day, in correlation with their birth-weight and gestations; with the aim of optimizing assess thermoregulation by advocating Kangaroo Mother Care.

Initial Audit- March 2014

Sample Size

10 patients, data collected on the same day of all the patients admitted on the neonatal unit. All the babies were stable off respiratory support and were on the neonatal unit completing antibiotic treatment as well as establishing feeds.

Criteria 1. Temperature 2. Gestation 3. Birth Weight 4. Participation in Kangaroo Mother Care

Results Sample- 10 patients, 8 preterm babies and 2 term babies

Gestation- 2* 28 weeks gestation 4* 34 weeks gestation

1 Dr. Yetunde Odutolu- Global Link Volunteer Feb 2014 1* 34 weeks 2* Term Babies 1* Gestation unknown

Birth weight- Range 0.88kg to 2.5kg 1* <1kg 4* 1kg to 1.5kg 3* 1.5kg to 2kg 2* 2kg to 2.5kg

Participation in Kangaroo Mother Care 2 babies participating, 8 not participating

Temperature in correlation to birth-weight and gestation

Weight No Average Temp in °C Gestation Doing KMC <1 1 35.5 28 weeks 1 1- 1.5 4 34.9 28-32weeks 1 1.5-2.0 3 34.8 32- 34weeks 0 2.0-2.5 2 36.4 Term 0

Conclusion All the preterm babies were hypothermic with temperature as low as 34.8, only 2 babies had near normal body temperature at 36.4 both were above 2 kg.

Recommendations 1. All babies should have a temperature measured at least once a day. 2. Keep young infants dry and wrapped 3. Ensure that the room temperature does not fall 25°C 4. Aim to maintain babies temperature between 36.5- 37.5°C 5. Exclude other causes of hypothermia such as sepsis by taking a thorough history and examination

2 6. Once a baby is stable and off any respiratory support, parents should learn KMC and commence KMC as soon as possible.

Action Plan 1. Improve temperature measurements 2. Teach all parents of low birth weight and premature babies Kangaroo Mother Care 3. Re-audit before August 2014.

3 Dr. Yetunde Odutolu- Global Link Volunteer Feb 2014