Reducing rates of neonatal hypothermia at birth in Tanzania: a quality improvement initiative.

OBJECTIVE: The SMART aim was to reduce the rate of neonatal hypothermia by 50% and increase neonatal delivery room (DR) temperature by 0.6 °C. To explore the relationship between hypothermia reduction and early neonatal mortality <7 days. STUDY DESIGN: Prospective QI study using the Model for Improvement through three Plan-Do-Study-Act cycles (PDSA) in neonates <2000g. INTERVENTIONS: 1. Hypothermia Prevention Care Bundle, 2. In-Person In-Service Training and 3. Audit Implementation. RESULTS: At baseline, mean DR neonatal temperature of 35.9 ± 0.24 °C and rates of overall hypothermia of 99% [66% mild (36-36.4 °C), 33% moderate (32-35.9 °C)] were noted. From the first PDSA cycle, there were centerline (CL) shifts in mean temperature to 36.8 °C and incidence of hypothermia to 5.7% (5.7% mild, 0% moderate). Early mortality rates remained unchanged (CL 12.3%). CONCLUSION: Hypothermia was almost eliminated in the DR. Because the overall neonatal mortality was unchanged there is insufficient evidence to support a causal relationship between hypothermia and early mortality.