Development of Evidence-Based Practices for the Management of Neonatal Hypothermia in the Newborn Nursery - PROJECT SUMMARY/ABSTRACT Neonatal hypothermia, defined by the World Health Organization as temperature below 36.5˚C, affects over 20% (>700,000/year) of late preterm and term infants in US newborn nurseries. Despite its prevalence, there is a significant knowledge gap regarding the clinical implications of hypothermia in this population. While hypothermia is associated with adverse outcomes in high-risk groups (premature or very low birth weight infants admitted to the neonatal intensive care unit), its clinical implications for late preterm and term infants in the nursery may not be as severe, potentially leading to unnecessary interventions. The proposed research aims to transform newborn care by investigating the impact of hypothermia on infant outcomes and resource utilization in the nursery, and by developing evidence-based best practices for its management. This serves as a foundational step in optimizing the treatment of neonatal hypothermia across US nurseries, which account for two-thirds of all childhood hospitalizations. Dr. Rebecca Dang is an ideal candidate to lead this research, with a strong foundation in clinical research and having published studies analyzing the epidemiology, interventions, and outcomes of hypothermia among ~24,000 late preterm and term infants at Stanford, which have informed this proposal. In the proposed research, Dr. Dang will spearhead this multi-institutional study of 8 university- affiliated nurseries within the Better Outcomes through Research for Newborns (BORN) Network. In Aim 1, she will analyze electronic health record data from these nurseries to assess the relationship between hypothermia and clinical outcomes and interventions. In Aim 2, she will conduct semi-structured interviews with healthcare professionals at these nurseries to provide rich data on hypothermia outcomes and factors that influence management. In Aim 3, she will employ a modified Delphi approach to develop evidence-based best practices for the management of neonatal hypothermia in US nurseries. Through these aims and the proposed training activities (advanced coursework, seminars, and structured mentoring from a multi-disciplinary team of advisors and mentors), Dr. Dang will develop expertise in 1) multi-institution studies, including data management, study design, and statistical analysis, 2) qualitative research methodologies, and 3) Delphi technique. The findings from the proposed research are expected to lay the groundwork for future R01-level proposals that will investigate the impacts of hypothermia best practices on infant outcomes and resource utilization, with an overall goal of advancing high-value care in neonatal hypothermia management. In summary, Dr. Dang’s successful single-institution studies, outstanding research and training environment at Kaiser Permanente Division of Research, exceptional team of dedicated and qualified mentors (including her newest internal advisor, Dr. Rita Mangione-Smith), and thoughtful research and career development activities will all poise her for success. In addition, this award will enable Dr. Dang to achieve her long-term career goals of establishing independence as a physician scientist and becoming a research leader in high-value pediatric medicine.
