Temperature Management of Outborn Preterm Infants During Inter-hospital Transfer After Birth

Preterm infants have higher mortality rates compared to Infants born at term, and require support after birth. Maintaining normal body temperature (normothermia, temperature 36.5°C-37.5°C) after birth is a challenge for preterm infants and abnormal temperature is associated with increased mortality. Preterm infants are at high risk hypothermia (temperature <36.5°C) or being over heated and becoming hyperthermic (temperature >37.5°C). Preterm infants who are transferred to another hospital after birth for their ongoing care (outborn) are at greater risk of morbidities and mortality than comparable inborn infants. I wished to study how effectively newly born preterm infants’ temperature is kept within the normal range during inter-hospital transport in Ireland. I reviewed the literature concerning temperature control in neonatal transport and identified issues relating to how infant temperature is measured, how thermal supports are used to assist preterm newborns, and inconsistencies in how thermal outcomes are reported. This review also highlights an increase in mortality for infants that are hypothermic following inter-hospital transfer. I performed a retrospective review and a prospective study of preterm infants undergoing inter-hospital transport after birth by the National Neonatal Transport Program. Infants rectal temperature was measured for the prospective study. We identified improved rates of hypothermia at all stages of transport by our transport service. However, this was offset by increasing rates of infant hyperthermia. In the study cohort, skin and axillary temperature were unreliable for detecting abnormal core (rectal) temperature. Thermal supports were infrequently used. Accurately measuring and appropriately managing infant temperature during neonatal transfer is crucial. Improved temperature monitoring during transport of preterm infants, and the use of polyethylene wraps for preterm infants during neonatal transport require further study to improve thermal outcomes.