Results from NAT Initiative show promising, meaningful clinical improvements in newborn healthcare

The NAT Initiative Executive Summary delivers background and overview information, results, key findings, and lessons learned from the Newborn Admission Temperature initiative.

The Newborn Admission Temperature (NAT) Initiative was the first TCHMB project to measure outcomes disaggregated by race and ethnicity from hospitals, an important step toward understanding and reducing disparities in perinatal healthcare and health outcomes in Texas. Of particular note are the following findings:

• The findings of decreased hypothermia among NICU admissions — in NICUs that consistently reported race and ethnicity disaggregated data — highlight the potential of statewide initiatives for improvement in settings caring for the most vulnerable newborns.

• The NAT Initiative identified significant disparities in hypothermia incidence, with newborns of non-Hispanic Black mothers having approximately twice the incidence compared to newborns of non-Hispanic White mothers.

More key findings, data, and conclusions & future directions are available in the NAT Initiative Executive Summary.

Hospitals Are Moving the Needle on Data Collection

The Newborn Admission Temperature (NAT) Project aims to improve the proportion of newborn babies with normal temperatures. We completed more than one year of data collection and early this fall released example evidence-based guidelines that hospitals can choose to use.

The NAT project has also produced benefits for implementing future QI projects and initiatives. For example, we asked hospitals to rate the statement “Being part of the NAT project helps us better report data by race and ethnicity.”

The proportion of hospitals that reported that their participation in the NAT project is helping them improve reporting of data stratified by race and ethnicity increase over the course of the initiative. In the first two data reporting cycles, only about one third (33-38%) of hospitals agreed with this statement, compared to nearly half (47%) of hospitals by the most recent data reporting cycle. (Click here to view the graph.)

Looking at the critical factors and conditions (challenges or barriers) that ensure effective practices are carried out and sustained for future practices is part of implementation science and it is equally as important as improving health outcomes for several reasons:

• Routinely reporting race/ethnicity through the NAT project might have a trickle-down effect as hospitals begin to build these processes within their own systems and projects; and

• The NAT project is the first TCHMB project that has documented outcomes by race and ethnicity and has set the stage for future TCHMB projects to do the same.  This is a strategy that cannot be understated given the disparities in maternal and neonatal outcomes in Texas.

Texas’ perinatal population is diverse and rapidly growing, and despite considerable improvement efforts, disparities in several key perinatal health indicators persist or have widened. Black mothers in Texas had higher rates of severe maternal mortality (SMM) than mothers of any other race or ethnic group over the past decade, and this disparity has widened since 2016.

High-quality, stratified data including race and ethnicity, at a minimum, can help reveal how different subpopulations are faring and track efforts to advance equity in health care and health outcomes. In this way, through its data collection process and through the participation of hospitals, the NAT project is breaking barriers while also working to eliminate disparities in perinatal health outcomes.

Read more about the new CDC grant that will work towards eliminating disparities in Texas.  

A Few Good Reasons for Neonatal Hospitals to Access the NAT Data Dashboard

Timely and accurate data is critical for Texas improve its perinatal outcomes. The new NAT Data Dashboard provides hospitals the opportunity to make improvements that will benefit babies across the state, especially those who are most vulnerable and susceptible to abnormal temperatures at delivery.

Texas has 227 neonatal hospitals that provide critical care to infants and their families. A majority of these are participating in the NAT project, TCHMB’s largest initiative to date. Hospitals submitted one year of data to NAT thus far, and it is the first time the data have been recorded across race and ethnicity. Hospitals can use this data (accessible now through the NAT Data Dashboard) to better understand potential risk groups and opportunities for improvement. Some disparities noted in the data include:

• Infants of black mothers have significantly higher prevalence of hypothermia than any other race/ethnicity at both NICU and Mother-Baby Units. However, the disparity is more significant at NICU.

• Infants with low birth weight have significantly higher prevalence of hypothermia and hyperthermia at NICU.

A few good reasons to access the NAT Dashboard:

• To show hypothermia and other balancing measures varying across hospitals

• To improve the quality of data collection

• To track improvement before and after implementing components of the example evidence-based guidelines

Watch the tutorial video for the NAT Dashboard here.

NAT is TCHMB's largest Statewide Initiative to Date

The Newborn Temperature Admission (NAT) Project posted new data from the Jan.-March reporting period, showing a majority of hospitals participating, the largest initiative in TCHMB’s history. When the April-June 2022 data is complete (due July 31st), the hospital level data will be shared back via the dashboard. The hospital level dashboard can establish a “baseline” and prepare for implementing evidence-based guidelines to increase the proportion of newborn infants with admission temperatures within normal limits. Read the Jan.-March summary report here.

Key Points:

• An astounding 76 percent of enrolled hospitals reported data for the period.

• There are currently 160 hospitals enrolled, making it TCHMB’s largest statewide initiative to date.

• This is the first time a TCHMB initiative has tracked data by race/ethnicity.

Why it matters:

By tracking data from each hospital, the NAT project can complete statewide analyses, including by region or type and size of hospital, as well as hospital-specific analyses.

Testimonials from NAT Project Ahead of Hospital-Level Dashboard

Only July 31, 2022, hospitals actively participating in the Newborn Admission Temperature Project will submit another round of data, marking one full year of data collection. This data will allow TCHMB to provide participating hospitals with hypothermia prevalence at their own hospitals, and more. Having a full year of data means that the estimates are more reliable, and can provide meaningful insights into patterns at the state and regional levels.

The NAT project is the largest in TCHMB history with 160 hospitals enrolled. During the most recent round of data reporting, over 75% of enrolled hospitals submitted data to TCHMB. See what some hospitals are saying, after nearly one year of participating in the NAT project:

With 25,000 deliveries a year, we were faced with a daunting project to obtain race and ethnicity on each newborn and collect temperatures according to the different parameters for well baby and NICU. We leveraged our ability to create documentation reports and perform data analysis to avoid the manual tracking and chart review, cutting down manual validation by an estimated 95%.

- Memorial Hermann Health System

The project was a definite challenge for our institution because of the large number of patients we care for. Obtaining data was very labor intensive and required working with a data architect to get a custom report built. Building the report, obtaining data outside of our NICUs and validating data were all challenges we encountered which required a lot of time, but we eventually overcame those challenges.

- Texas Children’s Hospital

In 2019-2020, Doctors Hospital of Laredo (DHL) solely tackled the newborn admission temperature QI project knowing that thermoregulation is the holy grail of neonatology. Huge strides were made towards adequate thermoregulation of the newborn, bringing DHL very close in achieving the goal.

In late 2020, when TCHMB announced the QI initiative of Newborn Admission Temperature (NAT) to increase newborn health care quality and patient safety; DHL did not hesitate in enrolling.  We are hopeful in reaching the goal and provide quality care to every single baby born at DHL by participating in the state-wide NAT project.

Thank you for allowing us to participate.

- Doctors Hospital of Laredo

If your hospital has questions about the project or needs technical assistance in reporting to the project, visit NAT Office Hours, every Wednesday from 12-2 p.m. CST.

A Majority of Birthing Hospitals Enrolled in NAT Project

The Newborn Admission Temperature (NAT) Project is a TCHMB Quality Improvement project to increase the number of newborn infants with admission temperatures within the normal limits – released hospital-reported data from Oct.-Dec. 2021. The project uses this data to inform hospital quality assurance and performance improvement programs, ultimately affecting positive outcomes for infants who are at risk for illness, disease or death if they do not fall in the normal limits.  

From October to November 2021:  

• 3.1% of infants had hypothermia and 5.9% of infants had hyperthermia at admission to the NICU;  

• 0.5% of infants had hypothermia and 3.3 % of infants had hyperthermia at admission to the Mother-Baby Unit;  

• Very low birthweight infants were significantly more likely to have hypothermia and hyperthermia at NICU admission. 

TCHMB continues to work with the RAC Perinatal Care Region (PCR) Alliance in order to connect with every single hospital stakeholder across the state. The current number of enrolled hospitals is 158. It continues to be geographically well-represented across TX. In this reporting period, NAT project covered approximately 58% of annual deliveries in Texas (compared to 51% for the July-September 2021 reporting period).  

The summary is available on the NAT project page. 

Newborn Admission Temperature (NAT) Project Update

The Neonatal Committee of the Texas Collaborative for Healthy Mothers and Babies (TCHMB) has completed two data collection periods for the Newborn Admission Temperature (NAT) Project. Of the 157 hospitals enrolled, 110 (70%) have submitted data for the most recent (second) data collection period. Overall, data quality has improved since the first data collection period, with more hospitals submitting data stratified by race/ethnicity. The NAT team is currently working on a report that will be published to the website in the coming month.

For hospitals needing additional support, we will provide weekly “NAT Office Hours” on Wednesdays from 12-2pm. Please feel free to drop in any time during these sessions for individual support. If you need the link for the meeting or if this time does not work for you, please reach out to us at nat@utsystem.edu.

Webinar: Introduction to TCHMB’s Newborn Admission Temperature Initiative

TCHMB invites you to participate in an introductory webinar for the NAT initiative on March 24 from 3-4pm. This webinar will be the official launch of the project where we will be discussing more details about the initiative including the importance of tracking newborn admission temperature, the data measures, and techniques and strategies for data collection for the project. Please invite your NAT team members to participate in the webinar to learn more and prepare for the project.

When: Mar 24, 2021 03:00 PM Central Time (US and Canada)

Topic: Introduction to TCHMB’s Newborn Admission Temperature Initiative

Register Now for this webinar.

After registering, you will receive a confirmation email containing information about joining the webinar.

If you have any questions, please reach out to Dr. Meliha Salahuddin at nat@utsystem.edu.