Every Degree Counts-A Quality Improvement Initiative to Reduce Neonatal Hypothermia during Transport

Abstract Background: Neonatal hypothermia is a frequent and preventable complication during transport, especially in low- and middle-income countries. It is associated with increased mortality and morbidity, particularly in preterm and low birth weight infants. At DVVPF Hospital, Ahilyanagar, the baseline incidence of admission hypothermia in transported neonates was alarmingly high at 62%. This Quality Improvement (QI) initiative aimed to reduce hypothermia through protocol-driven interventions. Objectives: · To reduce the incidence of admission hypothermia (<36.5°C) in transported neonates from 62% to below 20% over a 13-month period. · To improve adherence to a 5-point thermal care protocol from baseline 60% to ≥90%. Methods: This was a single-center, time-series QI study conducted from December 2023 to December 2024 in the NICU of DVVPF Hospital. Using root cause analysis (Fishbone diagram), key factors contributing to hypothermia were identified. Five Plan-Do-Study-Act (PDSA) cycles were implemented, focusing on equipment readiness, standardized thermal care protocol, and nurse-led training. Axillary temperature was measured upon arrival, and protocol adherence was documented for each transport. Results: A total of 104 neonates were transported during the study period. The incidence of hypothermia reduced from 62% in December 2023 to 15% by December 2024. Protocol adherence improved from 60% to over 90%. A strong positive correlation (r = 0.84) was noted between adherence and normothermia. No serious adverse events or over-warming episodes were reported. Conclusion: Simple, low-cost, and nurse-led QI interventions can significantly reduce hypothermia during neonatal transport. Sustained improvement was achieved through structured protocols, staff engagement, and regular monitoring. This model is replicable in resource-limited settings, reinforcing that every degree truly counts in neonatal survival.