Reducing prematurity-related neonatal mortality: a quality improvement project in Gandhi Memorial Hospital, Addis Ababa, Ethiopia.

Abstract

Background: Neonatal deaths refer to infants who die within the first 28 days of life, and they account for almost 50% of all child deaths under the age of 5 globally. Preterm birth is the primary reason for neonatal deaths, and it can lead to various complications that may prove fatal for newborns, such as respiratory distress syndrome, sepsis and intracranial haemorrhages. There was a high rate of neonatal mortality at Gandhi Memorial Hospital. 57.7% of neonatal deaths were caused by premature-related problems according to Pareto chart analysis. The baseline mortality rate among premature neonates admitted to the Neonatal Intensive Care Unit (NICU) was 20.7%. The objective of this quality improvement project was to reduce prematurity-related neonatal death at Gandhi Memorial Hospital.

Methods: A multidisciplinary quality improvement team used a fishbone diagram to analyse the causes of neonatal deaths related to prematurity. We used the Institute for Healthcare Improvement (IHI) model for improvement, using Plan-Do-Study-Act cycles to measure progress and make data-driven decisions.

Interventions: Transporting premature neonates born in the labour ward to NICU with CPAP, increasing the use of a continuous positive airway pressure (CPAP) device with an integrated oxygen concentrator, blender and compressor, and implementing the infection prevention checklist with four components were the implemented change ideas.

Results: The run chart showed a 25.6% reduction in prematurity-related neonatal mortality after implementing three interventions, and evidenced by a shift below the baseline median.

Conclusion and recommendation: The quality improvement project involving three interventions which are transporting premature neonates from labour ward to NICU with CPAP, using a CPAP device with an integrated oxygen concentrator, blender and compressor for preterm neonates and infection prevention checklist use with four components at Gandhi Memorial Hospital effectively reduced prematurity-related neonatal death. To improve neonatal outcome in premature neonates, we recommend that hospitals should prioritise implementing a standardised CPAP transport protocol, increasing a CPAP device with an integrated oxygen concentrator, blender and compressor use in the NICU, and fully implementing the infection prevention Checklist.