A regional quality-improvement collaborative to reduce early neonatal hypothermia in critically ill newborns

Early postnatal hypothermia (EPH) remains a significant clinical concern in critically ill transported neonates. A previous regional study reported an alarming EPH incidence rate of 82.1%, with wide variation across delivery facilities, underscoring the urgent need for quality improvement (QI) in early body temperature management. This study aimed to reduce the percentage of EPH in critically ill transported newborns by 20% to 25% within 1 year.

A standardized, evidence-based thermal care bundle and comprehensive staff training were implemented using multiple Plan-Do-Study-Act (PDSA) cycles starting May 1, 2023. Neonates transported from six referral hospitals in the pre-QI phase (January 1, 2022-April 30, 2023) were compared with those in the intervention period (May 1-December 31, 2024). Clinical characteristics, EPH incidence, and early outcomes within 7 days were analyzed.

A total of 1,247 neonates transferred from six referral hospitals were included, with 457 newborns in the pre-QI group and 790 in the post-QI group. Baseline characteristics were similar except for higher maternal intrapartum fever in the post-QI group (1.0% vs. 3.1%, P=0.02). Following implementation of the thermal management protocol, the incidence of EPH significantly decreased from 82.1% to 59.0% (adjusted P<0.001). A marked reduction in severe intraventricular hemorrhage (IVH) (grade ≥3) was observed, from 2.6% to 0.2% (adjusted P=0.002). No significant difference was observed in mortality, pulmonary hemorrhage, shock, hypoglycemia, disseminated intravascular coagulation (DIC), nor invasive mechanical ventilation use.

Implementing a standardized thermal management protocol substantially reduces EPH incidence in critically ill transported neonates. Avoiding EPH is beneficial for improving short-term outcomes.