Introduction of a Warming Bundle to Reduce Hypothermia in Neonatal Surgical Patients
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New article review by Dr. Alex Halpern!
Joshua K Ramjist, Pattamon Sutthatarn, Christine Elliott, Kyong-Soon Lee, Annie Fecteau
https://www.jpedsurg.org/article/S0022-3468(24)00068-X/abstract
Introduction: Hypothermia in the neonatal surgical population has been linked with significant morbidity and mortality. Our goal was to decrease intra and postoperative hypothermia.
Intervention: In November 2021, a radiant warmer and hat were included along with standard warming methods prior to the start of General Surgery procedures to minimize episodes of hypothermia.
Primary outcome: Core body temperature was measured pre, intra and post-operatively.
Methods: Data were prospectively collected from electronic medical records from July 2021 to March 2023. A retrospective analysis was performed. Hypothermia was defined as a temperature <36.5C. Control charts were created to analyze the effect of interventions.
Results: A total of 277 procedures were identified; 226 abdominal procedures, 31 thoracic, 14 skin/soft tissue and 6 anorectal. The median post-natal age was 36.1 weeks (IQR: 33.2-39.2), with a pre-surgical weight of 2.3 kg (IQR: 1.6-3.0) and operative duration of 181 min (IQR: 125-214). Hat and warmer data were unavailable for 59 procedures, both hat and warmer were used for 51 % procedures, hat alone for 29 %, warmer alone for 10 % and neither for 10 % of procedures. Over time there was a significant increase in hat utilization while warmer usage was unchanged. There was a significant increase in the mean lowest intra-operative temperature and decrease in proportion of hypothermic patients intra-operatively and post-operatively.
Conclusions: The inclusion of a radiant warmer and hat decreased the proportion of hypothermic patients during and after surgery. Further studies are necessary to analyze the impact on surgical outcomes.
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Can a warming bundle reduce hypothermia in neonatal surgical patients? I'm Alex Halpern, a research fellow at Children's National, and this is an article that you should know. The team from the Hospital for Sick Children in Toronto performed the Quality Improvement Project from 2021 to 2023 trying to answer this question. They introduced a warming bundle which included a radiant warmer and a hat before neonatal surgical procedures. They then prospectively collected data on 277 procedures performed between July 2021 and March 2023. They found that in procedures where the warming bundle was used, the neonates were less likely to be hypothermic both intraoperatively and postoperatively, and these patients had a significant increase in their lowest intraoperative temperature. So, it seems like a warming bundle can decrease rates of hypothermia in neonatal surgical patients. Does this information change your practice at all? Let us know what you think in the comments below.