Preventing hypothermia in preterm newborns - simple principles for a complicated task

Effect of Hot Water Bottles on Body Temperature during Magnetic Resonance Imaging in Dogs under General Anesthesia: A Retrospective Study

Prevention of hypothermia induced by anesthesia and enhanced by low environmental temperatures is difficult in magnetic resonance imaging (MRI) examinations in dogs as forced warming devices, including magnetic materials, are not acceptable for use in the MRI room. A hot water bottle (HWB) can be carried into an MRI examination room and can contribute to the prevention or attenuation of hypothermia. Here, we retrospectively investigated the effects of HWB on body temperature during MRI examinations in dogs under general anesthesia (GA). From anesthesia records of the Veterinary Medical Teaching Hospital, Okayama University of Science, validated data of 100 dogs that underwent an MRI examination under GA were obtained and divided into the following two groups: one group received HWB, while the other did not. Decrease in rectal temperature 15 min after intubation was significantly smaller in the group using HWB than in the group without HWB. In conclusion, the use of hot water bottles might be one of the methods to attenuate hypothermia in the early period but should not be expected for complete prevention of hypothermia, and it was not recommendable necessarily for body temperature management during MRI examinations in dogs under general anesthesia.

Using a Plastic Drape to Reduce Hypothermia in Premature Neonates During Peripherally Inserted Central Catheter Placement

BACKGROUND

Premature neonates require assisted heating devices for thermoregulation in the neonatal intensive care unit (NICU). Traditional use of a cloth blanket and cloth towels during peripherally inserted central catheter (PICC) placement may hinder heat transfer from the assisted heating mechanisms, increasing the risk for neonatal hypothermia.

PURPOSE

This quality improvement project's goal was to reduce the hypothermia rate in very low birth-weight (VLBW) neonates by replacing cloth blanket/towels with a plastic drape during PICC placement.

METHODS

The FOCUS-PDSA method was used to implement the intervention (plastic drape) over 3 months, during 58 PICC procedures in a level 3 NICU. A pre-/posttest design was used to evaluate the impact of the intervention on hypothermia rates compared with a baseline cloth group and a concurrent cloth cohort.

RESULTS

After the 3-month implementation period, the hypothermia rate for the intervention group was lower than that for the baseline cloth group (5.2% and 11.3%, respectively), but this difference was not statistically significant. Post-PICC hypothermia rates were significantly lower for the intervention group than for the concurrent cloth cohort (P = .004).

IMPLICATIONS FOR PRACTICE

Preliminary evidence demonstrated the plastic drape reduced the hypothermia rate in the NICU for VLBW neonates during PICC placement compared with cloth blanket/towels. A plastic drape shows promise in improving nursing practice by providing improved thermoregulation for premature neonates during PICC placement.

IMPLICATIONS FOR RESEARCH

Further research is recommended to replicate findings with larger samples of PICC insertions, using a plastic drape in the operating room and other NICU procedures.

Engaging Frontline Providers Prevents Hypothermia and Improves Communication in the Postoperative Neonate

BACKGROUND

Neonates undergoing surgery are at high risk for perioperative hypothermia. Hypothermia has been associated with increased adverse events. Transfer of care from the operating room (OR) to the neonatal intensive care unit (NICU) adds another layer of risk for this population introducing the potential for miscommunication leading to preventable adverse events.

PURPOSE

The aim of this quality improvement initiative is to decrease mean postoperative hypothermia rate and achieve compliance with use of a standardized postoperative hand-off in neonates transferred to the NICU from the OR.

METHODS

An interdisciplinary team identified opportunities for heat loss during the perioperative period. The lack of standardized perioperative communication between the NICU and the OR and postoperative communication between neonatology, anesthesiology, surgery, and nursing were noted. Guidelines for maintaining euthermia in the perioperative period and a standardized interdisciplinary postoperative hand-off communication tool were created.

FINDINGS/RESULTS

Mean rate for participation in the hand-off process increased from 78.8% to 98.4% during the study period. The mean hypothermia rate improved from 28.6% to 6.3% (P < .0001) and was sustained.

IMPLICATIONS FOR PRACTICE

Creating a hypothermia guideline and standardizing temperature monitoring can significantly decrease the rate of postoperative hypothermia in neonates. Standardization of transfer of care from OR to NICU increases consistent communication between the services.

IMPLICATIONS FOR RESEARCH

Future research and improvement efforts are needed to optimize the management of surgical neonates through their transfers of care.

Prevention of hypothermia in newborn submitted to surgical procedures: an integrative review

OBJECTIVE

to discuss in the scientific literature the strategies used to prevent hypothermia in newborns undergoing surgical procedures.

METHODS

this is an integrative literature review, with structured search in April and May 2020 in 08 databases, using the descriptors: Hypothermia; Surgical Procedures, Operative; Infant, Newborn; Protocols. Four primary studies were selected and analyzed using three instruments to assess the methodological quality of the Joanna Briggs Institute and content analysis.

RESULTS

Among the strategies used, the following stand out: room temperature control; establishment of humidification and quality of air conditioning cleanliness; use of a heated incubator or cradle; use of thermal mattress; use of caps and blanket; heated fluids; temperature monitoring and abdominal organ coverage.

CONCLUSION

good hypothermia prevention strategies were identified, despite the small number of publications on this topic; thus, it points out the need for research with strong evidence.

Physiologic Changes during Sponge Bathing in Premature Infants

In this study, we observed physiological reactions of premature infants during sponge bathing in the neonatal intensive care unit (NICU). The infants’ body temperature, heart rate, and oxygen saturation were monitored to examine hypothermia risks during bathing. The participants of the study were 32 premature infants who were hospitalized right after their birth in the V hospital in Korea between December 2012 and August 2013. The informed consents of the study were received from the infants’ parents. The infants were randomly assigned into two-day and four-day bath cycle groups and their physiological reactions were monitored before bathing as well as 5 and 10 min after bathing. The collected data were analyzed using the SPSS statistical package through t-test. A significant drop in body temperature was noted in both groups; that is, 4-day bathing cycle and 2-day bathing cycle (p < 0.001). However, there were no significant changes in heart rate or transcutaneous oxygen levels. There was no significant change between groups at each measurement point. In order to minimize the physiological instability that may be caused during bathing, the care providers should try to complete bathing within the shortest possible time and to make bathing a pleasant and useful stimulus for infants.