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The impact of a quality improvement project to reduce admission hypothermia on mortality and morbidity in very low birth weight infants

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Abstract

This prospective observational study was aimed to analyze the impact of a quality improvement project to reduce admission hypothermia on composite outcome of neonatal mortality and major morbidities. Infants with birth weight between 500 and 1499 g and gestation ≥ 25 weeks without major congenital malformations delivered between January 2018 and January 2020 who were admitted directly from delivery room to NICU were included in the study. Study period was divided in three phases including pre-intervention, intervention and post-intervention phase. There were a total of 368 VLBW infants included in the study. Mean admission temperature of neonates was 35.3 ± 0.6 °C, 36.0 ± 0.8 °C, and 36.4 ± 0.4 °C during pre-intervention, intervention, and post-intervention phase, respectively. Absolute incidence of composite outcome was 31%, 20%, and 13.2% during pre-intervention, intervention, and post-intervention phase, respectively. Risk of adverse composite outcome was significantly lower in post-intervention period as compared to pre-intervention period (aRR 0.68, 95% CI 0.49–0.92). Nosocomial sepsis and need for invasive ventilation was also significantly less in post-intervention period as compared to pre-intervention period.

Conclusion: Implementation of thermoregulatory interventions best suited to local settings help in significant reduction of neonatal hypothermia, which in turn can help to improve neonatal outcomes.

What is known:

• Admission hypothermia is associated with adverse neonatal outcomes.

• Implementation of quality improvement projects help reducing hypothermia incidence.

What is new:

• Implementation of quality improvement project to reduce admission hypothermia resulted in reduction in incidence of adverse composite neonatal outcome.

• Also implementation of quality improvement project led to reduction in incidence of nosocomial sepsis and need of invasive ventilation.

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Abbreviations

DR:

Delivery room

ELBW:

Extremely low birth weight

IVH:

Intraventricular hemorrhage

NEC:

Necrotizing enterocolitis

NICU:

Neonatal intensive care unit

QI:

Quality improvement,

VLBW:

Very low birth weight

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Author information

Authors and Affiliations

  1. Department of Neonatology, Fernandez Hospital, Hyderabad, India

    Deepak Sharma, Srinivas Murki, Dattatray Kulkarni, Dinesh Pawale, Venkateshwarlu Vardhelli, Rajendra Prasad Anne, Tejo Pratap Oleti & Saikiran Deshabhotla

Authors
  1. Deepak Sharma
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  2. Srinivas Murki
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  3. Dattatray Kulkarni
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  4. Dinesh Pawale
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  5. Venkateshwarlu Vardhelli
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  6. Rajendra Prasad Anne
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  7. Tejo Pratap Oleti
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  8. Saikiran Deshabhotla
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Contributions

Dr. Deepak Sharma conceptualised and designed the study, collected data and drafted the initial manuscript. Dr. Srinivas Murki conceptualised and designed the study, critically reviewed the manuscript and, approved the final version of the manuscript. Dr. Dattatray Kulkarni helped in data collection, planning interventions and manuscript writing. Dr. Dinesh Pawale coordinated and supervised data collection and performed data analysis. Dr. Venkateshwarlu vardhelli helped in developing protocol and in data collection. Dr. Rajendra Prasad Anne helped in planning of interventions and data analysis. Dr. Tejo Pratap Oleti developed initial protocol, conceptualised and designed the study, reviewed and revised the manuscript. Dr. Saikiran Deshabhotla coordinated implementation of various interventions, supervised data collection and reviewed the manuscript for important intellectual outcome.

Corresponding author

Correspondence to Deepak Sharma.

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Conflict of interest

The authors declare that they have no conflicts of interest.

Ethical approval

This article does not contain any studies with human participants or animals performed by any of the authors. Ethical approval number: 1_2018 – institutional ethics committee of Fernandez hospital, Hyderabad.

Informed consent

Research ethics committee approved the project without needing patient’s informed consent: 1_2018.

Additional information

Communicated by Daniele De Luca

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Sharma, D., Murki, S., Kulkarni, D. et al. The impact of a quality improvement project to reduce admission hypothermia on mortality and morbidity in very low birth weight infants. Eur J Pediatr 179, 1851–1858 (2020). https://doi.org/10.1007/s00431-020-03711-7

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  • DOI: https://doi.org/10.1007/s00431-020-03711-7

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