Impact of a quality improvement initiative on neonatal stabilization and admission patterns in a special care newborn unit in India

Background To reduce avoidable Special Newborn Care Unit (SNCU) admissions by 15% over a 4-month period through focused quality improvement (QI) interventions at a high-volume tertiary care hospital in Kolkata, India. Methods This QI study was conducted from August to November 2024. Baseline data revealed that 25% of weekly SNCU admissions were avoidable. A multidisciplinary team implemented evidence-based admission criteria, enhanced perinatal care practices, and strengthened postnatal monitoring. Key interventions included improved delivery room practices (respiratory support with CPAP, delayed cord clamping, early skin-to-skin contact, and early initiation of breastfeeding) and standardized triage protocols. Feeding support, prefeeding oromotor stimulation, antibiotic stewardship, and reverse transport to nearby SNCUs were also integrated. Four Plan-Do-Study-Act (PDSA) cycles supported infrastructure planning, staff training, protocol implementation, and sustainability. Results Avoidable admissions declined from 25% to 10% over 4-months. Bed occupancy dropped from a peak of 125% to 102%. Process indicators improved significantly: delayed cord clamping increased from 30% to 88%, early initiation of breastfeeding from 40% to 90%, and exclusive breastfeeding at discharge from 67% to 81%. Admissions for neonatal jaundice decreased following the implementation of updated AAP guidelines, with 21% of cases managed without phototherapy. Only five re-admissions (0.59%) and one emergency NICU transfer (0.13%) occurred. Conclusions Neonatal care should extend beyond SNCU optimization to include strengthened delivery point and postnatal-ward practices. When integrated with protocol based SNCU management, this continuum helps reduce morbidity, ease overcrowding, enhance efficiency, and optimize resource utilization in high-burden, resource-limited settings.