|Author||Study type||Location||Population||Sample size||QI measure||Outcomes|
|Agarwal et al. 2007 ||Controlled before and after study||India||Neonates born within the obstetric teaching hospital||15,249||Package of interventions including rational practice, protocol usage, training and empowerment of nurses||
Mortality: 30% decline in NMR|
Length of admission: reduction from 8.6 days to 7.1.
Sepsis: reduction in deaths due to sepsis from 37.9 to 15.5%
Appropriate antibiotic use: antibiotics use decreased to 23.2%.
|Bastani et al. 2015 ||Randomised controlled trial||Iran||Mothers with preterm infants||91||A family centred care (FCC) programme||
Hospital admission/readmission: FCC group were significantly less likely to be rehospitalised, p = 0.04.|
Length of admission: 6.96 in FCC group, 12.96 in control group, p < 0.001.
Maternal satisfaction: FCC group were significantly more satisfied.
|Bhutta et al. 2004 ||Controlled before and after study||Pakistan||Very low birth weight infants||509||A step-down unit for mothers and babies||
Mortality: rates of survival increased, from 65 to 84% (p < 0.05).|
Length of admission: length of stay fell from mean of 34 to 16.
Patient weight gain: there was a reduction in mean weight at discharge from 1.6 to 1.289 kg (p < 0.001).
Patient infection rates: rates of overall nosocomial infections dropped significantly.
Sepsis: increased relative risk of culture proved neonatal sepsis (95% CI 0.92–1.26).
Severe illness: non-significant changes in rates of intraventricular haemorrhage, apnoeic spells, respiratory distress, and necrotising enterocolitis; significant decrease in patent ductus arteriosus rates.
Presence of hyperbilirubinaemia: rates fell from 28.8% to 17.9%.
|Cavicchiolo et al. 2016 ||Controlled before and after study||Mozambique||NICU residents—inborn and outborn patients of all gestational ages up to the postnatal age of 7 days||4276||A continuous multi-level quality improvement intervention focused on infrastructure, equipment and protocol refinement||
Mortality: reduction in death rate from 26 to 18%, significant.|
Hospital admission/readmission rate: admissions for prematurity, sepsis and asphyxia increased significantly.
Sepsis: admissions for sepsis increased significantly, deaths decreased non-significantly.
Severe illness: deaths for asphyxia increased significantly, admissions increased significantly.
|Clark et al. 2012 ||Controlled before and after study||Sierra Leone||Children presenting for emergency care||500||Training course based on ETAT WHO course, ward combined to form ICU and ER, triage area created, improved equipment, experienced nurses in triage, structured clerking pack introduced||
Mortality: decreased from 12.38 to 5.85%.|
Length of admission: no change.
|Crouse et al. 2016 ||Controlled before and after study||Guatemala||Random sample of all patients presenting to the PED and all patients admitted to the PICU||1027||Emergency Triage Assessment and Treatment (ETAT)-based emergency triage process||
Mortality: decreased from 12 to 6% amongst critically ill, not significant.|
Hospital admission/readmission: admission from the Paediatric Emergency Department fell significantly from 8 to 4%, and also fell significantly in critically ill group.
Length of admission: decreased, not significant.
|Darmstadt et al. 2005 ||Controlled before and after study||Bangladesh||Preterm infants in Special Care Nursery||–||Infection control programme||
Mortality: decline in deaths of certain causes, significance not mentioned.|
Patient infection rates: decrease in nosocomial infection reports, and K. pneumoniae.
Infection detection rates: decline in cases of culture-proven sepsis and suspected sepsis.
Sepsis: significant decline in patients with clinical diagnosis of sepsis (79%).
Appropriate antibiotic use: antibiotic use guidelines were reviewed, no data.
Adherence to national guidelines of care: staff trained in standard guidelines, antibiotic guidelines were adhered to.
|dos Santos et al. 2015. ||Intervention study (non-random)||Brazil||NICU newborns||24||NIPS scale; non-pharmacological actions in pain control in newborns||Adherence to national guidelines of care: significantly lower NIPS (pain scale) score with intervention.|
|Erdeve et al. 2008 ||Intervention study (non-random)||Turkey||All mother−preterm infant dyads that were consecutively admitted to the NICU||60||Use of individual rooms||
Hospital admission/readmission: rehospitalisation rate was higher in non-intervention group p < 0.05.|
Length of admission: no significant difference regarding duration of intensive care hospitalisation.
Patient weight gain: no significant change on discharge in body weight.
Breastfeeding practice: no significant change in groups regarding breastfeeding rates.
|Gathara et al. ||Controlled before and after study||Kenya||Sick newborns aged 0–7 days and malnourished children aged 6–59 months||798||Package of interventions including clinical guidance booklets, admission record form, a training course on emergency and admission care, external support supervision, local facilitation, performance assessment, and feedback||
Mortality: mortality was reduced by 3% post intervention in intervention group, control group was static.|
Appropriate antibiotic use: overdoses of penicillin were reduced in intervention vs control group, but overdoses of gentamicin were increased.
Adherence to national guidelines of care: documentation of gestation in weeks were increased in intervention group, and mean documentation score was higher. More vitamin K was prescribed in intervention groups.
|Gilbert et al. 2014 ||Controlled before and after study||Brazil||Neonates admitted to NICU||1242||A 5-phase POINTS of Care package||
Mortality: crude survival rates did not change over time significantly except in one NICU where it decreased.|
Patient weight gain: days to regain birth weight were significantly higher in post-intervention period.
Retinopathy of prematurity: no significant change.
Sepsis: rates did not change—11.3/12.3 cases per 1000 infant days.
Lower respiratory tract disease: non-significant increase in bronchopulmonary dysplasia.
Severe illness: non-significant increase in bronchopulmonary dysplasia, no change in necrotising enterocolitis.
|Leng et al. 2016 ||Controlled before and after study||China||Very low birth weight neonates||172||Use of radiant warmers, warmer delivery room, STABLE programme, consulting services, standardised transportation, education of staff, review and feedback||
Mortality: mortality rates decreased from 12 to 7%, p = 0.03.|
Length of admission: reduced from 60 to 45 days, p = 0.01
Sepsis: sepsis rates did not change significantly.
Hypothermia rates: significant decrease in patients with temperatures < 36 degrees Celsius.
Lower respiratory tract disease: percentage with chronic lung disease did not change significantly.
Severe illness: rates of intraventricular haemorrhage and necrotising enterocolitis did not change significantly, but SNAPPE-II score increased significantly.
|Mais et al. 2015 ||Controlled before and after study||Lebanon||Neonates with central lines in NICU||213||Theoretical and practical teaching sessions, dressing change guidelines, sterile technique, auditing adherence to guidelines||
Length of admission: there was no significant change.|
Patient infection rates: CLABSI rates declined significantly, p < 0.05.
Mechanical ventilation: no significant change.
Central line duration: no significant decline in usage.
|Namazzi et al. 2015 ||Controlled before and after study||Uganda||All pregnant and newly delivered mothers residing within the villages of the Iganga/Mayuge Health and Demographic Surveillance Site||–||District led training, support supervision, mentoring, supply of essential medicine and equipment||
Mortality: hospitalised NMR declined from 17 to 9%, not significant.|
Kangaroo Mother Care: by the end of the study, 547 preterm babies had been cared for in a KMC unit.
Premature delivery rate: rate was 8% in deliveries in health units.
|Pinto et al. 2013 ||Controlled before and after study||Brazil||Newborns with very low birth weight||136||Dissemination of a new protocol proposed by the Brazilian National Health Surveillance Agency for antibiotic usage in LBW infants||
Mortality: overall mortality decreased from 20.9 to 4.4%, significant.|
Patient infection rates: no significant change in multi-resistant infection rates.
Sepsis: no difference in relation to confirmed sepsis, but a significant reduction in diagnoses of probable sepsis.
Severe illness: no change in diagnoses of severe illnesses, e.g., PDA, PBD, necrotising enterocolitis.
Appropriate antibiotic use: decrease in number of antimicrobial regimens used and days of antibiotic use.
|Rahman et al. 2017 ||Controlled before and after study||Bangladesh||Children identified as having systemic sepsis||1036||Triage, fast assessment, immediate results, immediate antibiotics, training package, slow charts, checklist, records system, infection control measures, equipment stocking||
Mortality: mortality decreased, significance not reported.|
Length of admission: increase in % with syndromic sepsis staying for over 48 h, significance not reported.
Appropriate oxygen use: post intervention 94% were given oxygen with hypoxaemia.
Appropriate antibiotic use: first-line recommended antibiotic usage increased from 49 to 75%, p < 0.005.
|Ramaswamy et al. 2015 ||Controlled before and after study||Ghana||Obstetric and neonatal cases in regional referral facilities||–||Ridge-Kybele model for obstetric and neonatal care—an integrated approach to systems change||
Adherence to national guidelines of care: 37% improvement in NICU hand hygiene rates.|
Waiting times: 74% reduction in mothers with unacceptable waiting times.
|Rosenthal et al. 2012 ||Controlled before and after study||Argentina, Colombia, El Salvador, India, Mexico, Morocco, Peru, the Philippines, Tunisia, Turkey||NICU patients||6829||VAP (ventilator-associated pneumonia) bundle—11 items||
Patient infection rates: ventilator-associated pneumonia rates per 1000 mechanical ventilator days decreased from 17.8 to 12.0.|
Lower respiratory tract disease: ventilator-associated pneumonia rates per 1000 mechanical ventilator days decreased from 17.8 to 12.0.
Adherence to National Guidelines of Care: hand hygiene compliance rates rose from 62 to 81%.
Mechanical ventilation: days of MV did not change.
|Rosenthal et al. 2013 ||Controlled before and after study||El Salvador, Mexico, Philippines, and Tunisia||NICU patients with central line insertion||2214||INICC multidimensional infection control approach||
Patient infection rates: CLABSI rate reduction from baseline of 54%, 95% CI 0.33–0.63 RR.|
Adherence to National Guidelines of Care: hand hygiene and sterile gauze rates rose significantly.
|Salehi et al. 2015 ||Controlled before and after study||Iran||Hospitalised ‘infants’||100||Implementation of guidelines and education||Patient weight gain: patients in intervention group had a mean weight change of + 96 g compared to − 59, p = 0.001.|
|Sethi et al. 2017 ||Controlled before and after study||India||Preterm neonates||26 neonates, 23 mothers||CPNC—comprehensive post-natal counselling package, comprising education of health care providers and family members||Breastfeeding practice: the proportion of mothers expressing milk on day 1 increased to 86.6% from 12.5%, after 1 year the proportion of neonates on exclusive breast milk was more than 80%.|
|Soni et al. 2016 ||Controlled before and after study||India||Infants admitted to a rural Indian neonatal intensive care unit (NICU)||648||Presence of physician champions||
Length of admission: length of stay was greater with champions, at 9 days, compared to 7 without, p = 0.01.|
Patient infection rates: patients who experienced infections decreased significantly as physician champions left.
Appropriate antibiotic use: no association between champions and antibiotic usage.
Breastfeeding practice: breastfeeding rates were not changed.
Usage of Kangaroo Mother Care: skin to skin care increased with champions and lasted longer hours per day.
Premature delivery rate: with KMC champions there was a higher percentage of premature deliveries, p = 0.01 for trend.
|Srofenyoh et al. 2012 ||Controlled before and after study||Ghana||Mothers and neonates in Ridge Regional Hospital||29,508||An interdisciplinary approach, high-level sponsorship, establishment of guidelines, measurement, feedback, leadership and teamwork coaching, training including QI training, and a multimodal focus on patients, providers, and systems||
Mortality: perinatal mortality was reduced, no information on significance.|
Maternal satisfaction: this improved.
Maternal health: 34% decrease in maternal mortality.
Stillbirth: reduced by 36%, p < 0.05.
|UNICEF 2014 ||Controlled before and after study||Bangladesh||Hospitalised newborns||–||Quality improvement initiatives delivered alongside SCANUs—Special Care Newborn Units||
Mortality: average case fatality rates dropped in most SCANUs.|
Hospital admission/readmission: admissions at SCANUs increased.
|Wrammert et al. 2017 ||Controlled before and after study||Nepal||Neonates in maternity hospital, Kathmandu||299||Implementation of Helping Babies Breathe Protocol||Mortality: decrease in death rate in first 24 h, p < 0.01. No significant change in 7/28 day mortality.|
|Yawson et al. 2016 ||Controlled before and after study||Ghana||Users of Ghanaian newborn care service||–||BNA tool to identify service gaps with group discussions, leading to national and regional operational plans and monitoring/evaluation framework||Mortality: mortality reduced in the intervention regions.|
|Zhou et al. 2013 ||Controlled before and after study||China||All neonates who received mechanical ventilation for at least 48 h and were hospitalised in the NICU for ≥ 5 days||491||A bundle of comprehensive preventive measures against VAP were gradually implemented using the evidence-based practice for improving quality method.||
Mortality: mortality rates decreased from 14% in phase 1 to 3% in phases 2 and 3, statistically significant.|
Patient infection rates: sustained decline in VAP rates, p = 0.01.
|Zhou et al. 2015 ||Controlled before and after study||China||Neonates in the NICU||171||EPIQ programme—team taught for 2 days, who then identified strategies for adoption of CLABSI prevention, and trained other members||
Patient infection rates: CLABSI rates declined in each successive phase.|
Central line duration: time in situ increased across the phases, significance not reported.