Improving Care for NICU Babies:

Keeping Babies Pink, Warm, and Sweet

August 01, 2025

Featured Stories

Urszula Mazur, a 25-year veteran NICU nurse, understands the importance of keeping newborns “pink, warm, and sweet” (a mnemonic referring to care practices around oxygenation, thermoregulation, and glucose levels).

This is especially important for babies admitted to the NICU where she works - a busy, 30-bed unit at Trillium Health Partners, Credit Valley site. The unit is designated a Level 2C which means they can care for babies as young as 30 weeks gestation.

Preterm babies are at greater risk of hypothermia (body temperature below 36.5°C) and associated sequelae (hypoglycemia, respiratory distress syndrome, jaundice, and metabolic acidosis). In severe cases, hypothermia can also result in death. When Urszula realized that many babies being admitted to the NICU were ‘cold-stressed’ she took action.

For the last 5 years, Urszula has been responsible for submitting their unit’s neonatal data (including temperature upon admission) into the BORN Information System (BIS). She noticed a trend, “A lot of our small babies and premature babies were coming to our unit cold. Not all of them but quite a few. Those tiny guys – like 2 kilos – were coming in with temperatures of 36.2°C and 35.8°C.”

Urszula checked the BORN NICU Dashboard which confirmed her observation. The NICU Dashboard is an audit and feedback tool that clinicians and administrators can use to monitor their unit’s performance on 2 clinical indicators (called Key Performance Indicators, KPIs).

Using a green/yellow/red signal, the dashboard can serve as an alert when best practice is not being met. The temperature KPI was red (signaling that performance improvement was needed).

Urszula is also a member of Trillium Health Partners’ Neonatal Council so she tabled the issue at this forum. The group had just finished working on a thermoregulation protocol for transitioning babies out of incubators and into cots so it was a good time to talk about temperature upon admission. She described the problem and showed the BIS data. The result? A new quality improvement initiative called “The Golden Hour”.

Spearheaded by a nurse practitioner, physician, and several nurses, the golden hour protocol is a systematic, evidence-based approach to caring for newborns during the first hour of life.

The team is exploring why some babies are coming to the NICU cold. Urszula has a few theories, “I wondered if it had anything to do with cesarean sections because the rooms are not very warm. Or perhaps delayed cord clamping, as that’s fairly recent especially in the cesarean section rooms. So babies might be out there on the belly in the cold room for a full minute if they’re stable enough to do delayed cord clamping”.

By drilling into data in the BIS, the team can look for trends and see if the issue is specific to any sub-groups (i.e. babies born via cesarean section). This information can be used to inform solutions.

Urszula will be sending monthly BIS reports to the nurse practitioner leading the “Golden Hour” initiative. Using these reports and the NICU dashboard, the team will be able to monitor the effect of any practice change they implement. Their goal: ensure babies are pink, warm, and sweet… and change the dashboard to green.

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