A regional quality-improvement collaborative to reduce early neonatal hypothermia in critically ill newborns

Background: Early postnatal hypothermia (EPH) remains a significant clinical concern in critically ill transported neonates. A previous regional study reported an alarming EPH incidence rate of 82.1%, with wide variation across delivery facilities, underscoring the urgent need for quality improvement (QI) in early body temperature management. This study aimed to reduce the percentage of EPH in critically ill transported newborns by 20% to 25% within 1 year. Methods: A standardized, evidence-based thermal care bundle and comprehensive staff training were implemented using multiple Plan-Do-Study-Act (PDSA) cycles starting May 1, 2023. Neonates transported from six referral hospitals in the pre-QI phase (January 1, 2022-April 30, 2023) were compared with those in the intervention period (May 1-December 31, 2024). Clinical characteristics, EPH incidence, and early outcomes within 7 days were analyzed. Results: 3.1%, P=0.02). Following implementation of the thermal management protocol, the incidence of EPH significantly decreased from 82.1% to 59.0% (adjusted P