Aim Neonatal hypothermia has a high incidence in low resource settings, even in tropical climates. It is associated with increased morbidity (hypoglycaemia, respiratory distress, metabolic acidosis, failure to thrive) and mortality. Hypothermia is classified by the WHO as mild (36–36.5°C), moderate (32–35.9°C) or severe (<32°C).
We aimed to audit neonatal admission temperatures, in a rural hospital; introduce simple measures to optimise newborn thermal care and reduce the incidence of hypothermia, using WHO recommendations.
Methods Neonatal admission temperatures were taken using an axillary thermometer. A baseline audit was conducted. A threshold of 0.5oC below the standardised core temperature cut-offs for classification was used, to account for use of an axillary thermometer. Pyrexial infants (axillary temperature > 37.5°C) and neonates admitted from home were excluded. Patients with moderate/severe hypothermia were considered “hypothermic”. Hospital-wide teaching, promoting WHO “warm chain” recommendations (e.g. immediate drying, minimal exposure to cold air) and kangaroo mother-care, was performed; a radiator was placed next to the maternity unit ‘resuscitaire’; hot water bottles were provided for the outdoor transfer of neonates from the maternity to neonatal unit; local staff were engaged and motivated with regular feedback of ongoing audit results and monthly targets.
Results Pre-intervention, the baseline incidence of admission hypothermia (July ‘14–January ‘15) was 76% (mean). All staff received teaching on optimising newborn thermal care (n = 32). Following the intervention, neonatal hypothermia reduced to 18% over a 4-month period (see Figure 1). The significant reduction has been sustained, over 6 months post intervention, as staff continue to respond to regular feedback of their efforts to minimise hypothermia, using WHO recommendations.
Conclusion Neonatal hypothermia is a significant problem in the developing world. The role of audit in quality improvement should not be underestimated, as combined with education, engaging and motivating staff and simple measures, such as using hot water bottles for outdoor transfer of newborn babies, regular audit feedback of staff performance has had a significant impact, with a sustained reduction in neonatal hypothermia from 76% to 18%.
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