Preventing Perioperative Hypothermia in Neonatal Surgical Patients: A Phased Quality Improvement Initiative within...

Neonates are at high risk for perioperative hypothermia, which is associated with increased morbidity and mortality. A serious safety event involving profound postoperative hypothermia prompted a quality improvement initiative to prevent perioperative hypothermia in neonatal intensive care unit surgical patients.

A review of prior cases at our institution demonstrated that only 50% of neonates returned from surgery normothermic.

A three-phase intervention was implemented: (1) a multidisciplinary hypothermia prevention checklist with standardized warming and transport processes; (2) assignment of a dedicated intraoperative "temperature guardian" responsible for continuous monitoring and team communication; and (3) implementation of dual-source intraoperative temperature monitoring. We collected perioperative temperature data across 39 consecutive surgical events.

Focused on standardizing preparation, clarifying team roles, enhancing intraoperative vigilance, and improving temperature measurement accuracy.

Implementation of phased interventions was associated with a reduction in hypothermia from 50% at baseline to 0% in subsequent phases, with elimination of hypothermia events and low rates of mild hyperthermia (≤20%), with 2 outlier events: 1 hypothermia emergency bedside procedure and 1 hyperthermia event with a falsely low core temperature reading during bowel irrigation. Checklist compliance improved to 92%. Intraoperative temperature monitoring compliance reached 100%.

A structured, phased quality improvement approach emphasizing team accountability, standardized workflows, and validated monitoring reliably maintained perioperative normothermia in high-risk neonatal patients and offers a reproducible model for improving neonatal surgical safety.