Tsingoglou and Wilkinson(2424 Tsingoglou S, Wilkinson AW. Heat loss during neonatal operations. Arch Dis Child. 1971;46:452. https://doi.org/10.1136/adc.46.248.452
https://doi.org/10.1136/adc.46.248.452...
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- Transport incubator temperature of 32ºC (29.2 to 35.6ºC average);
- NB covered to the shoulders with sweater;
- Room temperature of the operating room (22.7 to 28ºC, with average of 25.7ºC);
- Temperature of the microclimate (27.2 to 38.5ºC, with average of 32.4ºC);
- Relative air humidity during surgery ranged from 32% to 62%, with an average of 43%;
- Fixation of thermometer in the axillary, abdominal and close to the rectum region;
- NB temperature check at 15-minute intervals.
- Electric heated mattress (37 to 42ºC);
- All cleaning solutions and intravenous fluids except blood were kept in a cabinet at a temperature between 40 and 43ºC;
- Heated blood products. |
- 17 NB evolved with an average normothermia of 36.9ºC;
- 7 NB evolved with an average hyperthermia of 38.3 º C;
- 13 evolved with an average hypothermia of 35.9ºC;
- There were small temperature changes in the surgery, but some patients went to the operating room with subnormal temperatures;
- The postoperative period was quiet, except in a NB with septicemia (temperature of 39.5ºC) having to be cooled after the operation;
- The microclimate temperature varied between 32.8 and 42ºC.
- In the rapid infusion of 10 ml of cold blood a drop of 0.1ºC in the rectal temperature occurred in 7 patients, but this did not occur when the blood in the syringe was heated for the first time in the electric blanket. |
- Establish the temperature of 37 to 42ºC for the electric mattress;
- Before the surgery, NBs must be protected with some type of tissue, such as a blanket/blanket, since there is repeated opening of the incubator doors for NB examinations;
- When it is necessary to transfuse large volumes of blood, the microclimate may have to be kept at a higher temperature to avoid cooling NBs. |
Tander et al(2525 Tander B, Baris S, Karakaya D, Ariturk E, Rizalar Z, Bernay F. Risk factors influencing inadvertent hypothermia in infants and neonates during anesthesia. Paediatr Anaesth. 2005;15(7):574-9. https://doi.org/10.1111/j.1460-9592.2005.01504.x
https://doi.org/10.1111/j.1460-9592.2005...
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- Two temperature parameters were established for surgery on NBs: low (20.5 to 23ºC) and high (23.5 to 27ºC).
Perioperative interventions:
- Hot gel mattresses/compresses, with a temperature of 39ºC;
- Liquids and fluids heated to 37ºC;
- Blood products heated to 37ºC;
- The abdominal organs were covered with moist and warm compresses at 37ºC;
- Head, legs and arms covered with warm cotton pads;
- NB covered with heated surgical wrap. |
- The type of surgery and the operating room temperature are factors that affect NBs' temperature.
- Major surgeries were 2.66 times more likely to decrease core temperature;
- Operating rooms with temperature <23ºC have 1.96 times more chance of lowering the core temperature, compared to rooms with temperatures> 23ºC. |
- In major surgeries it is necessary to use thermal resources to guarantee NB normothermia;
- The operating room temperature must be adjusted according to the type and size of surgery;
- The main factors that predispose to hypothermia are: type of surgery and operating room temperature. |
Morehouse
et al(1111 Morehouse D, Williams L, Lloyd C, McCoy DS, Miller Walters E, Guzzetta CE, et al. Perioperative Hypothermia in NICU Infants. Adv Neonatal Care. 2014;14(3):154-64. https://doi.org/10.1097/ANC.0000000000000045
https://doi.org/10.1097/ANC.000000000000...
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- Performing a surgical procedure in two different environments, Neonatal Intensive Care Unit and operating room;
Perioperative interventions:
- Heated incubators or cradles with radiant heat;
- Caps, extra blanket, heated blanket;
- Chemical mattress and thermal mattress;
- heated intravenous fluids;
- Monitoring of axillary, nasopharyngeal, esophageal or rectal temperature.
Temperature record:
- Before transporting NB to the operating room;
- In the preoperative period, after delivery to the operating room team or the arrival of the surgical team at the Neonatal Intensive Care Unit;
- In the intraoperative period, continuous verification;
- In the postoperative period, check every 15 minutes, in the 1st hour; every 30 minutes, in the 2nd hour; every hour for 4 hours or until the temperature is stable. |
Hypothermia developed in 40% (n=43) of children during the perioperative period. The operating room group had a higher rate of perioperative hypothermia (65.45%, n=36; p <001) and were 7 times more likely to develop perioperative hypothermia (p=008) than the Neonatal Intensive Care Unit group (13.21%, n=7). Likewise, NBs in the operating room group were 10 times more likely to develop hypothermia during intra and postoperative periods than those in the Neonatal Intensive Care Unit group. (p=001). The hypothermic group had significantly more adverse respiratory events (p=025), were 6 times more likely to require thermoregulatory interventions (p <001).
Both groups experienced unacceptable rates of clinical hypothermia. |
- Use of a cap before and during surgery;
- Use preheated transport incubator and heated mattress when transferring to the operating room;
- Use of a cap before and during surgery;
- Use of a heated mattress during surgical procedures;
- Intravenous fluids must be preheated;
- In the postoperative period, NBs must return to a preheated bed;
- In family rooms of the Neonatal Intensive Care Unit, the room temperature must be set at 23.8 ºC. |
He et al(2626 He ZR, Lin TI, Ko PJ, Tey SL, Yeh ML, Wu HY, et al. The beneficial effect of air cleanliness with ISO 14644-1 class 7 for surgical intervention in a neonatal intensive care unit: a 10-year experience. Medicine (Baltimore). 2018;97(36):e12257. https://doi.org/10.1097/MD.0000000000012257
https://doi.org/10.1097/MD.0000000000012...
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- Performing a surgical procedure in two environments;
- Neonatal Intensive Care Unit: Room temperature from 23º to 26ºC, air humidity (50% to 60%), ISO 14644-1, evaluation of air conditioning cleanliness (Class 7);
- Operating room: room temperature at 18º to 22ºC, air humidity (55% to 75%), ISO 14644-1 evaluation of air conditioning cleanliness (Class 5 and 6).
- Before surgery, NB were transferred to an incubator and extra heaters for NB were added, according to body temperature. |
Average postoperative body temperature was significantly different between the 2 groups, although it was similar before surgery (36.4ºC in the Neonatal Intensive Care Unit group and 35.9ºC in the operating room group p=002).
The lowest body temperature during surgery was 35.2ºC in the operating room group, which was significantly lower than in the Neonatal Intensive Care Unit group (36.1ºC, p <001). Four patients (9.1%) in the Neonatal Intensive Care Unit group presented
hypothermia during surgery, compared with 27 patients (56.3%) in the operating room group (p <001). |
- Suggests that performing surgical procedures in a Neonatal Intensive Care Unit with air cleaning class 7 is as safe as in an operating room. |
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