title: Perioperative hypothermia in neonatal intensive care unit patients: effectiveness of a thermoregulation intervention and associated risk factors.
abstract: BACKGROUND
  Hypothermia in neonatal intensive care unit patients is associated with morbidity. Perioperative normothermia is the standard of care.
  
  
  OBJECTIVE
  We hypothesized that a quality improvement intervention (transport protocol, transport education, ongoing monitoring) would decrease the incidence of perioperative hypothermia. Secondarily, we hypothesized that patients undergoing surgery at a postmenstrual age of <37 weeks or at a weight of <1.5 kg would be at higher risk for perioperative hypothermia.
  
  
  METHODS
  Lean Six Sigma methodology was used to institute a quality improvement intervention. In a retrospective chart review, we identified 708 cases for which the neonatal intensive care unit was the preoperative and postoperative destination and documented patient characteristics, including postoperative temperature. Cardiac surgical cases and cases with no postoperative temperature record were excluded.
  
  
  RESULTS
  Patients in the postintervention group had a statistically significant decrease in hypothermia compared to those in the preintervention group (P < 0.001; OR: 0.17; 95% CI: 0.09-0.31). The absolute risk of hypothermia was 23% in the preintervention group and 6% in the postintervention group. Weight <1.5 kg on day of surgery (P = 0.45; OR: 0.63; 95% CI: 0.16-2.24) and postmenstrual age (P = 0.91; OR: 1.07; 95% CI: 0.33-3.98) were not risk factors. Odds of hypothermia were increased in patients undergoing interventional cardiology procedures (P = 0.003; OR: 17.77; 95% CI: 2.07-125.7).
  
  
  CONCLUSIONS
  Perioperative hypothermia is a challenge in the care of neonatal intensive care unit patients; however, a thermoregulation intervention can decrease the incidence with sustained results. Future studies can examine why certain procedures have a tendency toward increased perioperative hypothermia, determine the relative value of quality improvement interventions, and characterize the morbidity and mortality associated with perioperative hypothermia in neonatal intensive care unit patients.
authors.affiliation: Department of Anesthesiology and Critical Care Medicine, Division of Pediatric Anesthesia and Critical Care Medicine, Johns Hopkins School of Medicine, Baltimore, MD, USA.|Department of Pediatrics, Johns Hopkins School of Medicine, Baltimore, MD, USA.
authors.forename: Branden M
authors.initials: BM
authors.lastname: Engorn
authors.affiliation: Department of Anesthesiology, Division of Pediatric Anesthesia, University of Maryland School of Medicine, Baltimore, MD, USA.
authors.forename: Stephanie L
authors.initials: SL
authors.lastname: Kahntroff
authors.affiliation: Department of Nursing, Division of Pediatrics, Johns Hopkins University School of Nursing, Baltimore, MD, USA.
authors.forename: Karen M
authors.initials: KM
authors.lastname: Frank
authors.affiliation: Department of Anesthesiology and Critical Care Medicine, Johns Hopkins School of Medicine, Baltimore, MD, USA.
authors.forename: Sarabdeep
authors.initials: S
authors.lastname: Singh
authors.affiliation: Department of Pediatrics, Division of Critical Care Medicine, University of California - San Diego, San Diego, CA, USA.
authors.forename: Helen A
authors.initials: HA
authors.lastname: Harvey
authors.affiliation: Department of Anesthesiology, Division of Pediatric Anesthesia, Cohen Children's Medical Center, New York, NY, USA.
authors.forename: Charles T
authors.initials: CT
authors.lastname: Barkulis
authors.affiliation: Department of Anesthesiology and Critical Care Medicine, Division of Pediatric Anesthesia and Critical Care Medicine, Johns Hopkins School of Medicine, Baltimore, MD, USA.|Department of Pediatrics, Johns Hopkins School of Medicine, Baltimore, MD, USA.
authors.forename: Annika M
authors.initials: AM
authors.lastname: Barnett
authors.affiliation: Department of Anesthesiology and Critical Care Medicine, Division of Pediatric Anesthesia and Critical Care Medicine, Johns Hopkins School of Medicine, Baltimore, MD, USA.|Department of Pediatrics, Johns Hopkins School of Medicine, Baltimore, MD, USA.
authors.forename: Olamide O
authors.initials: OO
authors.lastname: Olambiwonnu
authors.affiliation: Division of Anesthesiology, Pain, and Perioperative Medicine, Children's National Health System, Washington, DC, USA.
authors.forename: Eugenie S
authors.initials: ES
authors.lastname: Heitmiller
authors.affiliation: Department of Anesthesiology and Critical Care Medicine, Division of Pediatric Anesthesia and Critical Care Medicine, Johns Hopkins School of Medicine, Baltimore, MD, USA.|Department of Pediatrics, Johns Hopkins School of Medicine, Baltimore, MD, USA.
authors.forename: Robert S
authors.initials: RS
authors.lastname: Greenberg
mesh_terms: D001831:Body Temperature; D003422:Critical Care / Q000379:methods*; D005260:Female; D006801:Humans; D007035:Hypothermia / Q000517:prevention & control*; D007231:Infant, Newborn; D007363:Intensive Care Units, Neonatal; D007431:Intraoperative Complications / Q000517:prevention & control*; D008297:Male; D019990:Perioperative Care / Q000379:methods*; D011183:Postoperative Complications / Q000517:prevention & control*; D012189:Retrospective Studies; D012307:Risk Factors
keywords: lean; neonate; quality; safety; six sigma; temperature