A practical strategy to reduce perioperative hypothermia in NICU patients

Neonates and infants undergoing surgery are at particularly high risk of developing hypothermia, as defined by a temperature less than 36 °C. Perioperatively, they are vulnerable to temperature dysregulation during transport to and from the operating room as well as exposure during the surgery itself. Additionally, their unique body composition makes heat conservation and thermoregulation challenging as compared to adults. Our aim was to reduce the rate of perioperative hypothermia in neonates and infants hospitalized in the neonatal intensive care unit (NICU) who underwent a surgical procedure. Our team utilized the Model for Improvement with sequential Plan-Do-Study-Act (PDSA) cycles to implement interventions aimed at reducing perioperative hypothermia rates. This included development of a hypothermia prevention bundle, creation of checklists and education tools for providers, regular case review and supplemental bundle interventions for the highest risk patients. Perioperative hypothermia rates decreased significantly to less than 5% after study interventions compared to a baseline rate of 16.9%. There was no change in the pre-specified balancing measure of postoperative hyperthermia. This quality improvement initiative, which prioritized implementation of a prevention bundle, addition of specialized bundle elements for high-risk cohorts, and regular case review, resulted in a decrease in perioperative hypothermia rates for NICU patients undergoing surgical procedures.