Effectiveness of Bundled Interventions for the Prevention of Neonatal Hypothermia in Low-Income Settings: A Quality Improvement Project in a Referral Hospital in Ethiopia.

BACKGROUND

Hypothermia at admission and in the following days is a major risk factor for neonatal mortality in both high- and low-resource settings. Implementing hypothermia prevention procedures is not an easy goal to achieve, and the few studies currently available in low-income countries focus mainly on temperature at admission. Deviation from normothermia does not exhaust its effects upon admission, with a demonstrated negative impact of hypothermia also during the first days of life.

OBJECTIVE

The aim of this study was to evaluate the effectiveness of bundled interventions in preventing neonatal hypothermia at admission and during hospitalization in a low-resource setting.

METHODS

This was a retrospective, observational, before-after study comparing a pre- (December 2023-February 2024) and a post-quality improvement intervention period (April-June 2024). The outcome measures included admission temperature, average temperature during hospitalization, number of hypothermia episodes, temperature checks per day during hospitalization, and mortality.

RESULTS

From the pre- to the post-intervention period, the median admission temperature increased from 35.6 °C to 36.0 °C ( = 0.004). Median temperature during hospitalization increased from 36.3 °C to 36.7 °C ( < 0.0001). Mild and moderate hypothermia episodes decreased from 1.0 to 0.5 and from 0.7 to 0.2 episodes per day ( < 0.0001).

CONCLUSIONS

In a Sub-Saharan referral hospital, the implementation of bundled interventions to maintain the warm chain improved neonatal temperature at admission and during hospitalization, and reduced hypothermia episodes during hospitalization.