Abstract:
Background: Premature infants face significant physiological challenges during the transition from intrauterine to extrauterine life, particularly in maintaining thermoregulation and respiratory function. Respiratory Distress Syndrome (RDS), caused by surfactant insufficiency, is a leading cause of morbidity and mortality in preterm infants. Hypothermia exacerbates RDS by increasing oxygen consumption, causing metabolic acidosis, and worsening respiratory failure. Globally, hypothermia incidence in preterm infants ranges from 32-85% in hospital births, with mortality rates reaching 8.5-52%. The World Health Organization recommends "warm chain" procedures to prevent heat loss in neonates. Warm chain bundles are evidence-based interventions designed to maintain normothermia in high-risk neonates.
Objective: This case study aimed to evaluate the effectiveness of implementing warm chain bundles on thermoregulation stability and respiratory outcomes in a premature infant with RDS receiving CPAP therapy in the NICU setting.
Method: A case study design was employed involving a preterm infant (36 weeks gestation, birth weight 1910 grams) diagnosed with RDS and requiring bubble CPAP support. The nursing intervention implemented warm chain bundles, including polyethylene plastic wrapping immediately after birth, warm hat application, thermal mattress use, incubator servo-control temperature regulation, and Kangaroo Mother Care (KMC). Data collection included comprehensive physical assessment, observation, parental interviews, and medical record review. The intervention was implemented over a 3-day period from March 6-8, 2026, at Budi Kemuliaan Hospital NICU.
Results: Initial assessment revealed mild hypothermia with axillary temperature 36.2°C, cold acral extremities, capillary refill time (CRT) 3 seconds, pallor, grunting, intercostal retractions, and SpO2 94%. After implementing warm chain bundles, axillary temperature increased from 36.2°C to 36.8°C within 24 hours and remained stable at 36.8-37.2°C throughout the 3-day observation period. Cold stress signs decreased, CRT improved to <2 seconds, and oxygen saturation stabilized at 95-98%. Respiratory parameters improved with FiO? reduction from 30% to 21% and CPAP weaning from PEEP 7 to room air by day 3. The Downe score decreased from 4 to 3, indicating improved respiratory status.
Conclusion: The implementation of integrated warm chain bundles effectively prevented hypothermia and maintained stable body temperature in this premature infant with RDS. Improved thermoregulation supported respiratory stability, enabling successful weaning of respiratory support. This case study supports the integration of warm chain bundles as a standard neonatal nursing intervention in the NICU. The findings are consistent with previous studies showing reduced hypothermia incidence from 79% to 22% following bundle implementation. The study highlights the crucial role of NICU nurses in ensuring consistent bundle application and emphasizes the importance of developing localized protocols incorporating warm chain bundles to improve neonatal outcomes.
Keywords: Premature infants, Hypothermia, RDS, Warm chain bundles
Biography:
Ns. Gita Bahari is a dedicated professional nurse with over 20 years of specialized experience in neonatal care. She currently serves as the Head Nurse of the Neonatal Intensive Care Unit (NICU) at arS Budi Kemuliaan. A graduate of the Nursing Profession program at Universitas Binawan, she combines her extensive clinical expertise with a passion for education. Beyond her leadership duties, Gita actively serves as a healthcare trainer, focusing her efforts on advancing neonatal knowledge and skills. Her career is defined by an unwavering commitment to improving the quality of life for the smallest and most vulnerable patients
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