REDUCTION IN NEONATAL HYPOTHERMIA DURING TRANSPORT: A QUALITY IMPROVEMENT STUDY AT A TERTIARY CARE HOSPITAL IN NORTH INDIA

Background: Neonatal hypothermia is a common but preventable cause of morbidity and mortality, particularly during inter-hospital transport of sick and preterm neonates. In our setting, nearly 38% of transported newborns were hypothermic on admission, prompting the need for a structured quality improvement initiative.

Aim: To reduce the incidence of admission hypothermia among transported extramural neonates by 50% over a 5-month period using targeted, low-cost interventions.

Methods: A prospective QI study was conducted at a level III NICU of a tertiary care hospital in North India from January to May 2025. The study included all outborn sick neonates transported to the NICU. The project used three sequential Plan-Do-Study-Act (PDSA) cycles, each addressing root causes identified through fish-bone analysis. Interventions included staff training on the “warm chain,” transport with cap and socks, servicing and pre-warming of transport incubator, and introduction of EMBRACE™ conductive thermal mattress. Data were analyzed using descriptive statistics (percentages).

Results: A total of 105 transported neonates were included. The mean axillary temperature increased from 35.2°C at baseline to 37.0°C during the sustenance phase. The incidence of hypothermia declined progressively from 38% (baseline) to 30.4%, 25%, and 13.6% across PDSA cycles 1–3, and was sustained at 10.5% thereafter. Preterm and low-birth-weight infants remained at higher risk, but severe hypothermia was eliminated. No infant developed hyperthermia during the study.

Conclusion: Sequential QI interventions using the WHO POCQI model effectively reduced hypothermia among transported neonates. Emphasis on training, equipment maintenance, and affordable thermal aids can ensure safe and warm transport of neonates in resource-constrained settings