Hypothermia rates halved in babies born before arrival at hospital, finds new research

Highlights  

• Hypothermia rates in babies born before arrival at hospital in the South West have halved, according to a new evaluation funded by Health Innovation South West.  

• Previous research drove changes to South West ambulance practice, guidance and 999-call handling processes.  

• A new audit comparing hospital data before and after these changes finds fewer babies are hypothermic on arrival at hospital, suggesting simple, evidence-based changes to service delivery can improve outcomes. 

• The findings also highlight persistent health inequalities in neonatal outcomes in the South West – and opportunities to tackle them.  

Rates of hypothermia in babies born before arriving at hospital in the South West have halved over the last five years, according to a new evaluation funded by Health Innovation South West.  

The repeat audit demonstrates how simple, evidence-based changes to service delivery can transform care in a rural and coastal place like the South West, as well as opportunities to tackle resident health inequalities in maternal and neonatal care.   

In 2021, Health Innovation South West funded research into births before arrival at hospital (BBAs) – when a baby is unexpectedly born at home, or in a car or ambulance, often without the presence of a qualified midwife or obstetrician. 

The study showed over a third of babies arriving at hospital via an ambulance following a BBA in the South West were hypothermic. It also identified potential risk factors for BBA in the South West and inequalities in the likelihood of neonatal hypothermia in the region, including among preterm babies, babies of first-time mums and of women with safeguarding concerns or who reported disabilities.  

In response to these findings, NHS Digital and the International Academies of Emergency Dispatch changed 999 call-handling processes for women giving birth before arriving at hospital. 

The findings also drove South Western Ambulance Service NHS Foundation Trust to implement changes including a new record page for newborns within their electronic patient care system, updated training, delayed cord clamping, and infant warming mattresses in all frontline vehicles. A poster campaign reminded paramedics to check and maintain newborn temperatures. 

An audit by SWASFT after these changes were introduced in 2024 revealed they had improved recording and management of prehospital thermal care for BBA babies, leading to a decrease in neonatal hypothermia during the prehospital episode. 

Now a reaudit of hospital data confirms that this decrease in neonatal hypothermia among babies born before arrival at hospital is reflected in hospital admissions, along with increases in advanced care for hypothermic babies, since these changes were made.  

The project, led by Dr Laura Goodwin, Associate Professor in Emergency Care at the University of West of England, Bristol, used routinely collected hospital data from five NHS hospital trusts in the South West. 

The reaudit found 17% of babies born before hospital arrived at hospital hypothermic, compared with 35% in the previous evaluation, and none of these babies were severely hypothermic. 33% more hypothermic babies received advanced care in the more recent evaluation, possibly reflecting increased recognition and escalation of care. 

This halving of hypothermia rates and improvement in subsequent care is particularly encouraging for a rural and coastal region like the South West, where access to services and travel times are limited, presenting added challenges for babies born before arrival at hospital. 

While the improvement is substantial, inequalities in neonatal temperature persist. Babies born preterm and babies of women with safeguarding concerns continue to experience higher risk of hypothermia on arrival at hospital.  

Said Dr Goodwin: 

This re-evaluation is important because it provides evidence on whether changes made in practice are being reflected in clinical indicators at hospital admission. While it is not possible to attribute changes to any single intervention, the findings are consistent with improvements in the recognition and management of neonatal hypothermia across the system.

It also highlights where further work is needed, particularly in addressing ongoing inequalities. Vulnerable pre-term babies are always likely to become colder quicker. But other inequalities, like those around safeguarding concerns, have the potential to be tackled.”  

Aimee Humphreys, Specialist Lead Midwife at South Western Ambulance Service NHS Foundation Trust, said:

As an ambulance service, we recognise the crucial importance of keeping babies warm when they are born outside of hospital. Over the past five years we have placed a strong focus on improving the care we provide to newborns, particularly those who are small and vulnerable. We have enhanced our training and guidance, upgraded our equipment, and refined our electronic patient record systems to empower our clinicians to deliver the best care possible.

Seeing neonatal hypothermia rates halve is a testament to the hard work and commitment of so many people across our organisation – from our quality improvement and education teams to our dedicated patient‑facing staff. We welcome Dr Goodwin’s findings and are thrilled to see that we are moving in the right direction.

While this progress is incredibly encouraging, we know there is still more work to do. We remain committed to continuing our improvements to ensure every baby born in our care has the safest possible start in life.” 

BBAs account for around 0.5% of UK births. Babies born outside of hospital are at risk of hypothermia and associated mortality, with pre-term babies much more likely to be hypothermic on arrival than term babies. 

Previously, paramedics did not consistently record newborn temperatures following BBAs in the South West, making it unclear if most newborns were becoming hypothermic in the prehospital environment or if paramedics were just measuring temperatures of babies they thought might be cold.  

Better management of hypothermia in newborns before arriving at hospital has the potential to improve outcomes and reduce inequalities in neonatal health by benefiting underserved groups.  

Health Innovation South West’s support over the years has enabled Dr Goodwin to develop a programme of work focused on improving care for babies born before arrival at hospital. This has included identifying the scale of neonatal hypothermia in the South West and working closely with ambulance services and call-handling organisations to support changes in local, national and international practice. 

Reflected Dr Goodwin: 

The programme of work funded by Health Innovation South West has enabled us to move beyond identifying a problem to supporting changes in practice and evaluating their impact in real-world settings.” 

The new evaluation provides important evidence to inform targeted quality improvement and service development for equitable care in the South West and beyond.  

The results have been shared with local and national stakeholders to inform policy, training and service planning.  

For more information about this programme of work and evaluation please contact [email protected].