Hypothermia in babies born before arrival at hospital
Summary:
Babies born unexpectedly outside of hospital are at increased risk of hypothermia, which can cause health problems for babies and increase the risk of neonatal death. This research showed that paramedics need access to more training and better equipment to ensure they can properly measure babies’ temperatures and keep them warm, while 999-call handlers’ scripts need to be updated so that parents receive the most effective advice on how to keep newborn babies warm.
Sands supported a research study from the University of the West of England to address the issue of hypothermia in babies born unexpectedly at home or outside of the hospital. The study focused on unexpected births where paramedics would be called out in emergency and did not include planned homebirths. The findings revealed that paramedics rarely recorded newborn babies’ temperatures, and that a third of these babies were hypothermic by the time they arrived at hospital.
The study identified several barriers that paramedics face, such as lack of suitable equipment, including special baby thermometers and warming mattresses, and prioritising the other emergency care tasks involved in looking after mother and baby. The research recommended improved training and providing better equipment for paramedics so they could measure babies’ temperatures and manage potential hypothermia more effectively.
Impact:
This research has already had significant impact, with the South West Ambulance service implementing new training and guidance for paramedics, improving the amount and quality of equipment available and introducing changes to electronic records to enable systematic recording of babies’ temperatures outside of hospital. Alongside this, changes have been made to the scripts used by 999 call-handlers to make sure parents are given the most effective advice about keeping their baby warm while waiting for paramedics to arrive after an unexpected birth.
The research has won awards, including the ‘research most likely to influence practice’ prize at the 999EMS conference for research about the emergency services. It has also had wider impact and been highlighted on local BBC news.
Associate Professor Laura Goodwin, who led the research at the University of the West of England, also kindly agreed to share her story with Sands.
More information
Why do we need this research?
Babies born unexpectedly outside hospital, known as Birth Before Arrival (BBA), face increased risk of hypothermia. Hypothermia increases the risk of worse outcomes for babies, including the risk of death. Pilot work showed that in the South West, a third of babies born before arrival at hospital would be hypothermic by the time they reached hospital. Paramedics and 999-call handlers are central to the care given and advice provided during births before arrival at hospital, but their experiences have not been explored before and neither had those of the parents who found themselves in these unexpected situations. This research aimed to understand what happens when babies are born unexpectedly outside of hospital and temperatures and how this affects how many babies become hypothermic before they reach hospital.
What were the aims of this study?
The study aimed to find out how often paramedics in the South West recorded the temperatures of newborns delivered before hospital arrival and to identify the challenges they faced in doing so. The research also aimed to determine which babies are most at risk of hypothermia and suggest ways to improve paramedics' ability to keep these newborns warm.
Alongside this, the study aimed to capture parents’ experiences of births before arrival with a focus on the conversations and advice given during 999 calls, to see if this affected how babies were kept warm before paramedics arrived.
What did the researcher do?
The study was conducted in two parts. First, the researcher analysed data from ambulance services to see how often temperatures were recorded and how many babies were hypothermic upon arrival at the hospital. They found that the vast majority of these babies did not have their temperatures recorded. They also tried to analyse data from hospitals and the ambulance service to work out if there were any demographic trends relating to births before arrival, but this proved impossible due to the different ways each hospital recorded data such as ethnicity.
In the second part, the researchers interviewed paramedics to understand the difficulties they encounter in measuring and managing newborn temperatures. They also reviewed 999 call transcripts to evaluate the advice given to parents about keeping babies warm after these unexpected births outside of hospital.
What impact did the study have?
The study revealed significant challenges faced by paramedics trying to measure and manage the temperatures of babies born before arrival at a hospital, including a lack of specialist thermometers, warming mattresses and a need for more training to prepare them for attending births before arrival, which are rare compared to many other emergency situations. The research also showed that the scripted advice 999-call handlers had to give to parents during these births did not focus enough on how to effectively keep babies warm.
As a result, several recommendations were made, including better training for paramedics, improved equipment, and clearer guidelines. This research has already led to changes in practice, such as a campaign to raise awareness among paramedics about the importance of temperature management and updates to electronic records used by the South West ambulance service. Changes have been made to the scripts used by 999 call-handlers to make sure parents are given the most effective advice about keeping their baby warm after birth.
More widely, this research has won awards, including the ‘research most likely to influence practice’ prize at the 999EMS conference, and has highlighted the importance of maternity-related research within emergency services.
Additional information:
Lead researcher – Laura Goodwin
Institution – University of the West of England
Funder – South West Academic Health Sciences Network
Duration – 2022 - 2023
Publications: