title: A quality improvement project to reduce hypothermia in infants undergoing MRI scanning.
abstract: BACKGROUND
  Hypothermia prevention strategies during MRI scanning under general anesthesia in infants may pose a challenge due to the MRI scanner's technical constraints. Previous studies have demonstrated conflicting results related to increase or decrease in post-scan temperatures in children. We noted occurrences of post-scan hypothermia in anesthetized infants despite the use of routine passive warming techniques.
  
  
  OBJECTIVE
  The aims of our quality improvement project were (a) to identify variables associated with post-scan hypothermia in infants and (b) to develop and implement processes to reduce occurrence of hypothermia in neonatal intensive care unit (NICU) infants undergoing MRI.
  
  
  METHODS
  One hundred sixty-four infants undergoing MRI scanning were prospectively audited for post-scan body temperatures. A multidisciplinary team identified potential variables associated with post-scan hypothermia and designed preventative strategies: protocol development, risk factor identification, vigilance and use of a vacuum immobilizer. Another audit was performed, specifically focusing on NICU infants.
  
  
  RESULTS
  In the initial phase, we found that younger age (P = 0.002), lower weight (P = 0.005), lower pre-scan temperature (P < 0.01), primary anesthetic technique with propofol (P < 0.01), advanced airway devices (P = 0.02) and being in the NICU (P < 0.01) were associated with higher odds for developing post-scan decrease in body temperature. Quality improvement processes decreased the occurrence of hypothermia in NICU infants undergoing MRI scanning from 65% to 18% (95% confidence interval for the difference, 26-70%, P < 0.001).
  
  
  CONCLUSIONS
  Several variables, including being in the NICU, are associated with a decrease in post-scan temperature in infants undergoing MRI scanning under sedation/general anesthesia. Implementation of strategies to prevent hypothermia in infants may be challenging in the high-risk MRI environment. We were able to minimize this problem in clinical practice by applying quality improvement principles.
authors.affiliation: Department of Anesthesiology, H187, Penn State Hershey Medical Center and Penn State Hershey Children's Hospital, 500 University Drive, Hershey, PA, 17033, USA. pdalal@hmc.psu.edu.
authors.forename: Priti G
authors.initials: PG
authors.lastname: Dalal
authors.affiliation: Division of Newborn Medicine, Penn State Children's Hospital, Hershey, PA, USA.
authors.forename: Janelle
authors.initials: J
authors.lastname: Porath
authors.affiliation: Department of Anesthesiology, H187, Penn State Hershey Medical Center and Penn State Hershey Children's Hospital, 500 University Drive, Hershey, PA, 17033, USA.
authors.forename: Uma
authors.initials: U
authors.lastname: Parekh
authors.affiliation: Department of Anesthesiology, H187, Penn State Hershey Medical Center and Penn State Hershey Children's Hospital, 500 University Drive, Hershey, PA, 17033, USA.
authors.forename: Padmani
authors.initials: P
authors.lastname: Dhar
authors.affiliation: Department of Public Health Sciences, Penn State College of Medicine, Hershey, PA, USA.
authors.forename: Ming
authors.initials: M
authors.lastname: Wang
authors.affiliation: Department of Radiology, Penn State Hershey Medical Center, Hershey, PA, USA.
authors.forename: Michael
authors.initials: M
authors.lastname: Hulse
authors.affiliation: Division of Newborn Medicine, Penn State Children's Hospital, Hershey, PA, USA.
authors.forename: Dennis
authors.initials: D
authors.lastname: Mujsce
authors.affiliation: Department of Anesthesiology, H187, Penn State Hershey Medical Center and Penn State Hershey Children's Hospital, 500 University Drive, Hershey, PA, 17033, USA.
authors.forename: Patrick M
authors.initials: PM
authors.lastname: McQuillan
mesh_terms: D000367:Age Factors; D000768:Anesthesia, General; D001835:Body Weight; D005260:Female; D006801:Humans; D007035:Hypothermia / Q000517:prevention & control*; D007223:Infant; D007231:Infant, Newborn; D007363:Intensive Care Units, Neonatal; D008279:Magnetic Resonance Imaging; D008297:Male; D011446:Prospective Studies; D058996:Quality Improvement; D012307:Risk Factors
keywords: Hypothermia; Infants; Magnetic resonance imaging; Neonatal intensive care; Quality improvement