Effectiveness of Bundled Interventions for the Prevention of Neonatal Hypothermia in Low-Income Settings: A Quality Improvement Project in a Referral Hospital in Ethiopia

Background: Hypothermia at admission and in the following days is a major risk factor for neonatal mortality in both high- and low-resource settings. Implementing hypothermia prevention procedures is not an easy goal to achieve, and the few studies currently available in low-income countries focus mainly on temperature at admission. Deviation from normothermia does not exhaust its effects upon admission, with a demonstrated negative impact of hypothermia also during the first days of life. Objective: The aim of this study was to evaluate the effectiveness of bundled interventions in preventing neonatal hypothermia at admission and during hospitalization in a low-resource setting. Methods: This was a retrospective, observational, before–after study comparing a pre- (December 2023–February 2024) and a post-quality improvement intervention period (April–June 2024). The outcome measures included admission temperature, average temperature during hospitalization, number of hypothermia episodes, temperature checks per day during hospitalization, and mortality. Results: From the pre- to the post-intervention period, the median admission temperature increased from 35.6 °C to 36.0 °C (p = 0.004). Median temperature during hospitalization increased from 36.3 °C to 36.7 °C (p < 0.0001). Mild and moderate hypothermia episodes decreased from 1.0 to 0.5 and from 0.7 to 0.2 episodes per day (p < 0.0001). Conclusions: In a Sub-Saharan referral hospital, the implementation of bundled interventions to maintain the warm chain improved neonatal temperature at admission and during hospitalization, and reduced hypothermia episodes during hospitalization.