Abstract

Background: Following prehospital birth, babies can become hypothermic within minutes, sometimes before paramedics arrive. The risk of the baby dying increases by at least 28% for every degree that their temperature drops below <36.5C. the earlier we can provide effective warming interventions, the lower the risk of poor outcomes. The aim of this project was to 1) examine the neonatal temperature management advice given to people calling 999 about a prehospital birth in the UK and 2) explore NHS staff and patient views about the content and accessibility of advice given.
Methods: All 999 calls between January 2021 and January 2022 were searched by the clinical information and records teams at two ambulance services using the two different triage systems (AMPDS and NHS pathways). Thirty eligible calls were selected from postcodes with varying levels of deprivation and passed to the study team for content analysis. Nine focus groups were held with 18 NHS staff (paramedics, midwives, neonatal nurses/doctors, call handlers), and 22 members of the public who had experienced prehospital birth, to discuss the content and accessibility of the advice given.
Results: Five themes were identified as potential barriers to good quality neonatal temperature management confusing or conflicting advice on where the baby should be placed following birth, vague or unclear instructions on warming the baby, the timing of temperature management advice, the priority given to other instructions, and a lack of importance placed on neonatal temperature. Participants suggested a number of simple changes to advice, including increased focus on the importance of neonatal temperature, encouraging skin to skin contact, and providing specific advice on warming the baby.
Conclusion: there is an opportunity to improve neonatal temperature management advice given by 999 call handlers during calls related to prehospital birth. This could reduce the number of babies arriving at hospital hypothermic, therefore improving outcomes.