Impact of quality improvement initiative on incidence of hypothermia in neonates in the delivery room.

Normothermia during the first hour of life predicts admission to neonatal intensive care unit (NICU) and improves the outcome for both sick and stable babies across all gestational ages. Immediate skin-to-skin contact (iSTS) offers a simple, effective approach to prevent hypothermia while enhancing feeding, survival, and bonding. The aim of this study is to implement a multidisciplinary quality improvement initiative addressing the barriers to optimal thermal care in the delivery room setting and establish sustainable protocols for preventing neonatal hypothermia across all gestational ages. The objective is to reduce the rate of hypothermia (temperature <36.5°C recorded just before transfer from the delivery room) from the existing 51.67% to <50% of the baseline data (<25.8%) in neonates over 12 weeks in the delivery room. This prospective Quality Improvement Study was undertaken to enhance newborn care in a tertiary-care hospital's delivery room from January 2024 to May 2024. A multidisciplinary team of Neonatologists/Pediatricians, Obstetricians, Anesthesiologists, OT staff, and Nurses identified problem areas using fishbone analysis. A situational analysis was conducted through process flow mapping, and three Plan-Do-Study-Act cycles were undertaken. In the first cycle, protocols were established through a multidisciplinary meeting involving consultants, pediatricians, anesthesiologists, and obstetricians. Resident doctors and nursing staff received educational sessions through manikin-based Objective Structured Clinical Examination drills. The second cycle focused on iSTS, maintaining optimal temperatures and ensuring equipment readiness in the operating room. During the third cycle, pre-operative counselling for mothers and sensitization of post-operative staff were implemented to further improve newborn care practices. Of the 148 neonates analysed (January 2024 to May 2024), hypothermia incidence (<36.5°C) decreased significantly from 51.67% to 13.16% (P < .001), representing a 74.5% relative improvement and an 85% reduction in odds (odds ratio = 0.15; 95% confidence interval: 0.08-0.28). Mean admission temperature increased from 36.2 ± 0.4°C to 36.8 ± 0.3°C (P < .001). Data collected on the incidence of hypothermia in cycles 1, 2, 3 showed hypothermia rates of 31.7%, 37.03%, and 22.58%, respectively, with cycle 2's increase attributed to heightened staff awareness and improved monitoring. STS ≥60 min increased from 25% to 85% (P < .001) and early breastfeeding from 30% to 78% (P < .001). The incidence of hypothermia was maintained at 13.16% through the 3-week sustainability phase, with no adverse events associated with the interventions. Implementation of simple evidence-based practices led to a significant decrease in hypothermia incidence in newborns after delivery. Immediate STS and using a head cap after birth are the two most important key interventions for preventing neonatal hypothermia in the delivery room.