Simple Measures Can Prevent Perioperative Hypothermia in Infants

By Will Boggs MD

March 21, 2020

NEW YORK (Reuters Health) - A few simple measures before, during and after surgery can reduce the risk of perioperative hypothermia in infants, according to a new report.

"Historically, we have known that babies are at risk for getting cold throughout the perioperative process," Dr. Beverly S. Brozanski of St. Louis Children's Hospital, in Missouri, told Reuters Health by email. "This project helped us to understand the extent of the problem and where to focus interventions."

Several organizations have provided recommendations for perioperative temperature management and prevention of unplanned hypothermia in infants.

Dr. Brozanski and colleagues developed and implemented a standardized process to maintain perioperative euthermia with an aim to decrease the incidence of hypothermia from a baseline of about 20% to 10% and to sustain that level over 12 months.

Their practice recommendations included temperature monitoring, heat-loss prevention during transport to and from the operating room, increase in ambient operating room temperature, and maintenance of intraoperative euthermia.

After project rollout at 19 participating sites in the Children's Hospitals Neonatal Consortium (CHNC) beginning in September 2013, a decrease in postoperative hypothermia rates from 20.3% to 13.2% was first noted in October 2013.

The postoperative hypothermia rate declined further to 10.5% by June 2014 and remained around 10% through November 2015, Dr. Brozanski and colleagues report in Pediatrics.

In parallel, there was a clinically insignificant increase in the rate of hyperthermia from 1.2% to 2.2%.

Preoperative patient temperatures in the neonatal intensive-care unit (NICU) were in the target range 95% of the time. And patient temperatures at the start and end of the surgical case were within target temperature 83.5% of the time. The average compliance with local heat-loss prevention during transport to and from the operating room was about 90.5%.

Centers that adopted the practice of prewarming the operating room and centers that achieved >90% euthermia target temperature rates at operating-room arrival and departure had lower adjusted odds of postoperative hypothermia. Surprisingly, however, centers achieving >90% compliance with warming protocols in transit to the operating room had higher adjusted odds of developing hypothermia.

"The most exciting part of this process was local multidisciplinary team (OR, Surgery, and NICU medical staff) working and learning together across centers to focus on various points in the process for improvement," Dr. Brozanski said. "CHNC is committed to mobilizing leaders across our organization to do this important work for our patients."

"There is no one way to address post-op hypothermia; it takes team collaboration to maintain this single outcome point," she said. "Centers that established fully engaged multidisciplinary teams reported the lowest hypothermia rates."

SOURCE: Pediatrics, online March 19, 2020.