STEPP IN: Working Together to Keep Infants Warm in the Perioperative Period

Brozanski, Beverly; Piazza, Anthony J.; Chuo, John; Natarajan, Girija; Grover, Theresa R.; Smith, Joan; Mingrone, Teresa; McClead, Richard E.; Rao, Rakesh; Rintoul, Natalie E.; Guidash, Judy; Bellflower, Bobby; Holston, Margaret; Richardson, Troy; Pallotto, Eugenia K.

doi:10.1542/peds.2019-1121

Cited by 27 publications

(32 citation statements)

References 25 publications

(8 reference statements)

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“…Axillary temperature, which is commonly used in NICUs [14] and in PACUs [70] is close to core temperature, at least in normal temperature ranges, but not as accurate. This When oesophageal monitoring is not feasible, e.g., due to surgical procedure, nasopharyngeal temperature is an adequate alternative and a reliable surrogate for core temperature [58,66].…”

Section: Other Sitesmentioning

confidence: 99%

“…On the other hand, some studies demonstrate that with an adequate protocol, hypothermia rates can be below 10% [ 14 , 15 , 16 , 17 ], even in preterm infants [ 18 ]. Thus, it seems that the rate of perioperative hypothermia depends more on the actual warming strategy, and less on patient factors, regardless of age or surgical procedure.…”

Section: Incidencementioning

confidence: 99%

“…Cold stress may induce multiple physiological pathways such as catecholaminergic response, vasoconstriction, increased metabolism, and decreased surfactant synthesis ( Figure 1 ). This may lead to pulmonary hypertension, tissue hypoxia, arterial hypotension and hypoperfusion of vital organs, metabolic acidosis, and hypoglycaemia [ 14 , 41 , 44 ]. The possible consequences may be apnoea and the need for mechanical ventilation, arrhythmias, increased risk of infections, prolonged length of hospital stay, poor neurologic outcome, and even death [ 14 , 38 , 53 ].…”

Section: Adverse Eventsmentioning

confidence: 99%

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Perioperative Hypothermia in Children

Nemeth

Miller

Bräuer

2021

IJERPH

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Background: First described by paediatric anaesthesiologists, perioperative hypothermia is one of the earliest reported side effects of general anaesthesia. Deviations from normothermia are associated with numerous complications and adverse outcomes, with infants and small children at the highest risk. Nowadays, maintenance of normothermia is an important quality metric in paediatric anaesthesia. Methods: This review is based on our collection of publications regarding perioperative hypothermia and was supplemented with pertinent publications from a MEDLINE literature search. Results: We provide an overview on perioperative hypothermia in the paediatric patient, including definition, history, incidence, development, monitoring, risk factors, and adverse events, and provide management recommendations for its prevention. We also summarize the side effects and complications of perioperative temperature management. Conclusions: Perioperative hypothermia is still common in paediatric patients and may be attributed to their vulnerable physiology, but also may result from insufficient perioperative warming. An effective perioperative warming strategy incorporates the maintenance of normothermia during transportation, active warming before induction of anaesthesia, active warming during anaesthesia and surgery, and accurate measurement of core temperature. Perioperative temperature management must also prevent hyperthermia in children.

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Section: Other Sitesmentioning

confidence: 99%

Section: Incidencementioning

confidence: 99%

Section: Adverse Eventsmentioning

confidence: 99%

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Perioperative Hypothermia in Children

Nemeth

Miller

Bräuer

2021

IJERPH

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“…Furthermore, the Children’s Hospitals Neonatal Consortium STEPP-IN initiative published results showing that a multi-institutional quality improvement project reduced postoperative hypothermia from 20.3% to 10.5%. 16 However, no studies have demonstrated sustained improvement below 10%. We aimed to reduce the percentage of postoperative temperatures <36°C in NICU patients from 10% to 6%, an approximately 40% reduction, over 6 months from May 1 to November 30, 2017, and sustain for 6 months, until May 1, 2018.…”

Section: Introductionmentioning

confidence: 99%

A Quality Initiative for Reducing Postoperative Hypothermia for Neonatal Intensive Care Unit Surgical Patients

Cronin

Soghier

Ryan

et al. 2020

Pediatric Quality &Amp; Safety

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Introduction: The association between hypothermia in the neonatal intensive care unit (NICU) patients and morbidity and mortality is well described. Neonates are at higher risk of perioperative hypothermia when compared to older children. Previous studies showed that quality improvement tools reduced postoperative hypothermia in NICU patients, but none showed sustained improvement at incidence rates of <10%. As a single institution, we aimed to reduce the percentage of postoperative temperatures < 36°C in NICU patients from 10% to 6% over 6 months and sustain for 6 months. Methods: An interdisciplinary team created a key driver diagram and implemented interventions, including monthly reporting of postoperative hypothermia incidence to the anesthesiologists, individual feedback sessions with the anesthesiologists, use of a perioperative checklist, and continuous axillary temperature monitoring of the infant throughout the perioperative period. Data were collected retrospectively using a chart review of electronic medical records. The primary outcome was the percentage of hypothermic patients (T < 36°C) based on the first postoperative temperature taken in the NICU. We tracked this measure using a statistical control chart and evaluated it using Plan-Do-Study-Act cycles. Results: From February 1, 2016 to May 30, 2018, data were collected for 554 patients (pre-intervention: 242 and post-intervention: 312). The percentage of surgical patients who returned to the NICU hypothermic decreased from 9.7% to 2.5% ( P < 0.002)—a change sustained for greater than 12 months. Conclusions: Quality improvement tools are useful in reducing postoperative hypothermia in NICU surgical patients and in maintaining these results.

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“…At the time, we noted that NICU patients at our institution were also having a relatively higher incidence of perioperative hypothermia at 44% as compared to the average national rate reported by the Children’s Hospital Neonatal Consortium of approximately 20.3%. 21 …”

Section: Introductionmentioning

confidence: 99%

A Quality Improvement Initiative to Improve Perioperative Hypothermia Rates in the NICU Utilizing Checklists

Hanna

Htun

Islam

et al. 2020

Pediatric Quality &Amp; Safety

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Background: Premature infants are at high risk for heat loss. Infants undergoing surgical procedures outside of the neonatal intensive care unit have an increased risk of hypothermia. Hypothermia can lead to delayed recovery, hypoglycemia, metabolic acidosis, sepsis, and emotional stress for the parents. We aimed to reduce the incidence of hypothermia for infants undergoing surgical procedures from a baseline of 44.4% to less than 25% over 3 years (2016–2018) with the utilization of a checklist and education. Methods: We conducted a retrospective chart review for all infants undergoing surgical procedures from 2014 to 2015 and prospective data for 2016–2018. Next, we created a multidisciplinary team, educated staff members, and instituted a checklist comprising 9 tasks. We conducted Plan-Do-Study-Act cycles quarterly and audited checklist compliance monthly. Results: From 2014 to 2015, the total incidence of perioperative hypothermia was 44.4% (n = 54). After the initiation of the checklist, the overall incidence of hypothermia decreased to 23.4% (n = 124, P = 0.007). Hypothermia occurred most frequently while the patient was in the operating room. Furthermore, we noticed that hypothermia was significantly associated with neonates requiring emergency procedures. There was an inverse correlation between overall compliance with checklist usage and the incidence of hypothermia. Conclusion: A checklist is a useful and simple tool for maintaining an optimal temperature for postsurgical neonates. Frequent re-education and enforcement of the protocol is necessary. Overall, implementation of the checklist, along with regular education, decreased the total incidence of perioperative hypothermia in the neonatal intensive care unit.

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STEPP IN: Working Together to Keep Infants Warm in the Perioperative Period

Abstract: OBJECTIVES: Reduce postoperative hypothermia by up to 50% over a 12-month period in children's hospital NICUs and identify specific clinical practices that impact success.

Cited by 27 publications

References 25 publications

Perioperative Hypothermia in Children

Perioperative Hypothermia in Children

A Quality Initiative for Reducing Postoperative Hypothermia for Neonatal Intensive Care Unit Surgical Patients

A Quality Improvement Initiative to Improve Perioperative Hypothermia Rates in the NICU Utilizing Checklists

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