Critically ill patients under 18 (newborns and preterm infants)

The critical preterm infant care team at Chi Mei Hospital's 4A ICU is grounded in professionalism, delivering high-quality, humanistic, and compassionate warm care that has become a hallmark of preterm infant care. The team is fully dedicated to providing seamless, end-to-end care for preterm infants—from birth to ICU admission—establishing a comprehensive risk assessment system to ensure fragile preterm infants and newborns grow steadily amid warmth and care, while also comforting parents' hearts. Through cross-disciplinary collaboration, the team integrates diverse care resources and continuously improves clinical practice. With institutional support, and in partnership with 3D printing teams and biomedical material manufacturers, the team innovatively developed the patented "Inflatable Warming Suit" and "Air-Cushioned Infant Nest," dedicated to enhancing the quality of thermoregulation care for preterm infants with the aspiration of becoming a benchmark in the field. These innovations not only strengthen clinical care capabilities but also demonstrate the team's significant contributions and influence in preterm infant care.

Key Technologies: A four-stage "Preterm Thermoregulation Bundle Care" protocol: pre-delivery prep → delivery/OR setup → transport → ICU care, each with clear guidelines. Two patented innovations developed cross-disciplinarily: "Inflatable Warming Suit" and "Air-Cushioned Infant Nest," plus a "Thermal Care Kit" for quick access, reducing missing-item risk.

Highlights: Low-temperature incidence at admission dropped from 54.2% to 6.16%; during hospitalization, from 7.3‰ to 3‰. Nursing compliance exceeds 90%; rewarming time cut from over 1 hour to under 30 minutes. 933 cases enrolled, with 10,801 patient-days in the 4A ICU.

Innovative Practices: Team mobilizes to delivery/OR for high-risk pregnancies for immediate intervention. Temperature care set as a specialty quality indicator with monthly monitoring and periodic protocol updates. Cross-industry collaboration with 3D printing and biomedical manufacturers translates R&D into clinical use.

International Achievements: "Inflatable Warming Suit": Silver, 2019 Seoul Invention Fair; Silver, Green Idea Competition. "Air-Cushioned Infant Nest": Gold, 2019 Green Idea Competition; Gold, 2022 Malaysia International Innovation Awards.

From 2019 to August 2024, the 4A ICU recorded an average annual admission volume of approximately 240 cases, an average length of stay of about 17.5 days, and an average bed occupancy rate of approximately 81.5%. Based on monthly quality indicator reports, since the launch of this quality improvement initiative in 2019, a total of 933 cases have received the "Preterm Infant Thermoregulation Bundle Care." Among these, 381 preterm infants were admitted directly to the 4A ICU immediately following birth, accumulating a total of 10,801 patient-days during their hospitalization in the 4A ICU.

• The incidence of hypothermia upon NICU admission for preterm infants decreased from 54.2% (prior to improvement, May 2018) to an average of 6.16% since improvement measures began in February 2019.

• The incidence of hypothermia during hospitalization for preterm infants decreased from 7.3‰ (prior to improvement, May 2018) to an average of 3‰ since improvement measures began in February 2019.

• Nursing staff compliance with temperature care protocols has consistently remained above 90%.

• When a preterm infant's body temperature falls below 36.5°C, prompt and proactive warming interventions are implemented. As a result, rewarming time has been shortened from approximately 1 hour or longer to within 30 minutes.

• Service Process Establishment: The team developed the "Preterm Infant Thermoregulation Bundle Care" protocol, dividing thermal care into four stages: (1) pre-delivery preparation, (2) delivery/operating room environment setup, (3) transport process, and (4) ICU care. Detailed care guidelines were established for each stage, providing nursing staff with clear operational standards to ensure consistent and effective temperature management for preterm infants across every stage.

• Nursing Innovation: Through cross-industry collaboration, the team developed the "Inflatable Warming Suit" and "Air-Cushioned Infant Nest," enhancing clinical usability and ensuring thermal stability—demonstrating the forward-thinking and practical application of nursing expertise in technology.

• "Thermal Care Kit" Implementation: Using a pre-assembled kit concept, the team streamlined preparation processes and reduced the risk of missing items, enabling immediate response and rapid access to ensure warm care reaches the ICU without delay.

• Quality Management Mechanism: Preterm infant thermal care was designated as a specialty quality indicator for the unit. Dedicated staff conduct monthly data monitoring and analysis, discussing and refining care strategies. Nursing protocols are also periodically revised to ensure continuous improvement in care quality and patient safety.

• Family Satisfaction Survey

• 100% satisfied with nest appearance (92.3% very satisfied)

• 100% satisfied with supportive positioning - 100% satisfied with thermal stability

• 100% satisfied with temperature care

• 100% satisfied with nursing professionalism

• 76.9% willing to purchase nest after discharge

• 92.3% willing to recommend to others Family Qualitative Feedback

• Attentive care for the child

• Professionalism demonstrated

• Nest provides security, increases stability

• Nursing Staff Satisfaction Survey (New Nest vs. Prior Models)

• Supportive positioning satisfaction: 95%

• Storage convenience satisfaction: 95%

• Appearance satisfaction: 90%

• Practicality/versatility satisfaction: 85%

• Ease of use/time efficiency: 80%

• Washability without deformation: 80%

• Wall collapse resistance: only 70%

• Size customization: only 55%

• Innovative Product – "Inflatable Warming Suit"

• Silver Medal, 2019 Seoul International Invention Fair, Korea.

• Silver Medal, 2019 Green Idea Invention and Design Competition.

• Invited oral presentation, 2019 International Conference on Pharmaceutical & Cosmetic Sciences and Health Biotechnology (ICPCH 2019).

• Invited oral presentation, 2019 International Symposium on Novel and Sustainable Technology (ISNST 2019).

• Innovative Product – "Air-Cushioned Infant Nest"

• Gold Medal, 2019 Green Idea Invention and Design Competition.

• Gold Medal, 2022 Malaysia International Innovation Awards.

• Special Award, 2022 Indonesian Invention and Innovation Promotion Association (INNOPA).

• Invited oral presentation, 2019 International Conference on Pharmaceutical & Cosmetic Sciences and Health Biotechnology (ICPCH 2019).

• Academic Presentations on Preterm Infant Thermoregulation Care

• Poster presentation, 2019 BMJ International Forum on Quality and Safety in Healthcare, Asia-Pacific Annual Conference.

• E-poster, ICN Congress 2021 – Nursing Around the World.

• E-poster, 2020 Taiwan International Nursing Conference, Endorsed by ICN.