Authors: Sangita Devi Moirangthem , Kanchana Ramachandran , Dania Amer Alhijjawi , Maha Hassan Eladly , Ahmed Zaki Mustafa

Abstract

Background: Newborn hypothermia, defined as an axillary temperature lower than 36.5°C, represents a major issue. It affects around 32% to 85% of newborns worldwide and is associated with an increased risk of complications. There is inadequate implementation of WHO guidelines in thermal care and limited evidence on the potential failures of their application.

Objectives: To significantly reduce the incidence of neonatal hypothermia Care Medical Hospital in Saudi Arabia by implementing the WHO thermal care guidelines.

Methods: The study was conducted at CARE Medical Al Rawabi in Saudi Arabia from December 2023 to June 2024. We implemented the 10 Steps to Warmth and followed a Six-Step Failure Mode and Effects Analysis (FMEA). Step 1: Identifying the process: Implementation of the WHO guidelines. Step 2: Identifying potential failure modes. Step 3: Rating the risk: Rating the occurrence, detection, and severity. Step 4: Develop action plans: Create strategies to reduce the occurrence, severity, or detectability of high-risk failure modes. Step 5: Implementing and monitoring: Implemented the action plans. Step 6: Re-evaluation: Periodically review the
FMEA.

Results: The data showed that the implementation of the 10 steps of warmth reduced the incidence of hypothermia in newborns in the labor and delivery ward from 21% to 0%. Meanwhile, hypothermia during transfer to the normal newborn nursery was reduced from 34% to 0%. The incidence of hypothermia in the neonatal intensive care unit was reduced from 43% to 0%. The incidence of hypothermia after the first bath was reduced from 42% to 0%. The compliance of skin-to-skin adherence reached 100% following vaginal delivery
and 95% following cesarean section.

Conclusion: The systematic implementation of the WHO 10 steps of warmth, using FMEA, reduced the incidence of hypothermia among newborns to zero and resulted in high adherence to skin-to-skin contact. 

Keywords: 10 Steps, Warmth, optimal thermal care, Newborns.