Quality Improvement Project for Reducing Hypothermia on Admission in Neonates Admitted in A Tertiary Care (Level 3A) NICU in Ahmedabad, Western India

Abstract

Title: Quality Improvement project for reducing hypothermia on admission in newborns admitted to a neonatal care unit in a large academic tertiary (Level 3A) NICU in Ahmedabad, Western India. Background: Neonatal hypothermia is a common and dangerous condition around the world. Moderate and severe hypothermia increase mortality and morbidity and predispose the fragile neonate to an increased risk of late-onset neonatal sepsis (LONS), intraventricular hemorrhage, and worsening of respiratory distress. Around 60% of neonates who are admitted to level 3 tertiary NICU in Ahmedabad, Gujarat, India, had a temperature below 36.5°C on admission. Method: We conducted plan-do-study-act (PDSA) cycles to test and adapt solutions for decreasing hypothermia in neonates admitted to NICU. Identifying the root cause of hypothermia in terms of Manpower, Material, and Methods and enlisting them as fishbone diagrams. We adopted the strategy of using a transport incubator in the Ambulance and turning on the incubator before thirty minutes of delivery for preventing neonatal hypothermia. Results: Within 8 months of starting our quality improvement project, the proportion of neonates who were hypothermic on admission decreased from 57% to 8%, Normothermic on admission increased from 23% to 53%, with an increase in mean admission temperature from 35.4°C during the pre-intervention phase to 36.6°C during post-intervention. There was also a reduction in the incidence of late-onset sepsis from 23% (pre-intervention phase) to 13% and subsequently 5% in the post-intervention period. Conclusion: This study is a cost-effective approach to reducing admission hypothermia in NICU in a resource-limited setting with all outborn babies. Our study also emphasizes the importance of maintaining euthermia, not only in delivery rooms but also during transportation.