Reducing Hypothermia Among Intramural Vaginally Born Preterm Neonates Admitted in Neonatal Intensive Care Unit at a Tertiary Care Centre Using Quality Improvement Approach.

OBJECTIVES: To reduce admission hypothermia (<36.5°C) in intramural preterm neonates delivered vaginally and admitted to the neonatal intensive care unit (NICU) at a tertiary care hospital in India. The study aimed to decrease the incidence of neonatal admission hypothermia from 80% by 50% using quality improvement (QI) approach.

METHODS: This QI study was conducted at a tertiary care centre in North India. The study included 138 preterm neonates (gestation <37 wk) born vaginally and admitted to the NICU. The Point of Care Quality Improvement tool (POCQI) was used with multiple Plan-Do-Study-Act (PDSA) cycles. Following baseline admission temperature data collection, the root cause analysis was conducted using fishbone analysis. Change ideas tested included maintaining labor room (LR) temperature, deferring weighing and vitamin K administration from LR to NICU, stabilizing temperature in LR before shifting to NICU, using pre-warming linens, additional layers of cloth and blankets along with plastic wraps during transport and staff education on standard operating procedures (SOP) to reduce admission hypothermia. Data were analyzed using RUN charts for effectiveness.

RESULTS: Baseline hypothermia incidence was 80%, with a median admission temperature of 35.3°C. Following implementation of QI interventions, hypothermia rates reduced significantly to near nil over the study period. Seasonal variations led to temporary fluctuations, but sustained improvements were achieved with continuous staff training and adherence to new SOPs.

CONCLUSIONS: The structured QI approach effectively reduced admission hypothermia among preterm neonates by implementing evidence-based thermoregulatory interventions.