758 - Warming Up to Better Outcomes: A Multi-Disciplinary Approach to Reducing Post-Operative Hypothermia in a Level IV NICU

Publication Number: 1734.758

Ilyse Richman, Joe DiMaggio Children's Hospital at Memorial Regional Hospital, Hollywood, FL, United States; Tamar Levene, Joe DiMaggio Children's Hospital at Memorial Regional Hospital, Hollywood, FL, United States; Noor Kassira, Joe DiMaggio Children's Hospital at Memorial Regional Hospital, Hollywood, FL, United States; Richard Elf, Joe DiMaggio Children's Hospital at Memorial Regional Hospital, Hollywood, FL, United States; Doron Kahn, Joe DiMaggio Children's Hospital at Memorial Regional Hospital, Hollywood, FL, United States

Background: Neonates face increased hypothermia risk from immature thermoregulation, exposure to anesthetic agents, cold ambient temperatures in operating rooms (ORs), and limited thermal protection during transport. Post-operative hypothermia (POH) delays recovery, raises infection risk and increases mortality. Inconsistent recovery practices prompted targeted multidisciplinary interventions at our 84-bed Level IV Neonatal Intensive Care Unit (NICU).

Objective: We sought to reduce our POH rate by 50% from 5.3% to 2.6% by December 31, 2023. We defined POH as a temperature of < 36°C upon NICU arrival from the OR.

Design/Methods: In November 2022, the incidence of POH was identified as an area for improvement. We established a NICU Surgical/Recovery Steering Committee with the goals of: 1) identifying and evaluating targeted thermal management strategies, 2) improving compliance with peri-operative temperature monitoring and warming protocols, and 3) boosting multidisciplinary staff awareness and adherence to neonatal thermoregulation best practices. Specifically, we created a temperature log (Figure 1) for NICU and surgical staff to track peri-operative temperatures and conducted fall-out analyses with anesthesia and surgical teams. This collaborative effort led to the implementation of thermal hats and heating blankets in the OR, as well as consistent OR temperature practices to promote normothermia. At project inception, patients recovered in the Post-Anesthesia Care Unit (PACU), but in March 2023, we introduced battery-powered shuttles which attached to isolettes, allowing for safe, heat-maintaining transport and direct recovery in the NICU, while maintaining available direct access to the neonates in case of emergencies. In April 2024, we expanded in-unit surgical care to include transcatheter patent ductus arteriosus closure by interventional cardiology. Data were presented at bi-monthly multidisciplinary meetings with neonatology, anesthesia and surgery as well as at internal meetings in the NICU.

Results: Surpassing our initial goal, our POH rates decreased 81% from 5.3% in 2021-2022 to 1% by December 2023 (Figure 2). Sustained multidisciplinary efforts have decreased our rate to zero for the past 14 months since August 2024.

Conclusion(s): Mitigating POH in NICU infants requires a unified, multidisciplinary approach. Through shared protocols, accountability, and timely feedback with practice evaluation, our team exceeded our goal of reducing POH rates, thereby enhancing recovery for our neonates undergoing surgical procedures.

Figure 1
PAS Abstract_ Figure 1_Temperature Log.pdf

Figure 2
PAS Abstract_Figure 2_Fall-out Run Chart.pdf