Risk factors and outcomes of intraoperative hypothermia in neonatal and infant patients undergoing general anesthesia and surgery

Jialian Zhao; Zhenkai Le; Lihua Chu; Yi Gao; Manqing Zhang; Jiabin Fan; Daqing Ma; Yaoqin Hu; Dengming Lai

doi:10.3389/fped.2023.1113627

Risk factors and outcomes of intraoperative hypothermia in neonatal and infant patients undergoing general anesthesia and surgery

Front Pediatr. 2023 Mar 15:11:1113627. doi: 10.3389/fped.2023.1113627. eCollection 2023.

Authors

Jialian Zhao¹, Zhenkai Le², Lihua Chu³, Yi Gao¹, Manqing Zhang¹, Jiabin Fan¹, Daqing Ma⁴, Yaoqin Hu¹, Dengming Lai²

Affiliations

¹ Department of Anesthesiology, Children's Hospital, Zhejiang University School of Medicine, National Clinical Research Center for Child Health, Hangzhou, China.
² Department of Neonatal Surgery, Children's Hospital, Zhejiang University School of Medicine, National Clinical Research Center for Child Health, Hangzhou, China.
³ Department of Anesthesiology, First Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, China.
⁴ Division of Anaesthetics, Pain Medicine & Intensive Care, Department of Surgery & Cancer, Faculty of Medicine, Imperial College London, Chelsea & Westminster Hospital, London, United Kingdom.

Abstract

Objective: The incidence of intraoperative hypothermia remains high in pediatric patients during anesthesia and surgery even though core body temperature monitoring and warming systems have been greatly improved in recent years. We analyzed the risk factors and outcomes of intraoperative hypothermia in neonates and infants undergoing general anesthesia and surgery.

Methods: The data on the incidence of intraoperative hypothermia, other clinical characteristics, and outcomes from electronic records of 1,091 patients (501 neonates and 590 infants between 28 days and 1 year old), who received general anesthesia and surgery, were harvested and analyzed. Intraoperative hypothermia was defined as a core temperature below 36°C during surgery.

Results: The incidence of intraoperative hypothermia in neonates was 82.83%, which was extremely higher than in infants (38.31%, p < 0.001)-the same as the lowest body temperature (35.05 ± 0.69°C vs. 35.40 ± 0.68°C, p < 0.001) and the hypothermia duration (86.6 ± 44.5 min vs. 75.0 ± 52.4 min, p < 0.001). Intraoperative hypothermia was associated with prolonged PACU, ICU, hospital stay, postoperative bleeding, and transfusion in either age group. Intraoperative hypothermia in infants was also related to prolonged postoperative extubation time and surgical site infection. After univariate and multivariate analyses, the age (OR = 0.902, p < 0.001), weight (OR = 0.480, p = 0.013), prematurity (OR = 2.793, p = 0.036), surgery time of more than 60 min (OR = 3.743, p < 0.001), prewarming (OR = 0.081, p < 0.001), received >20 mL/kg fluid (OR = 2.938, p = 0.004), and emergency surgery (OR = 2.142, p = 0.019) were associated with hypothermia in neonates. Similar to neonates, age (OR = 0.991, p < 0.001), weight (OR = 0.783, p = 0.019), surgery time >60 min (OR = 2.140, p = 0.017), pre-warming (OR = 0.017, p < 0.001), and receive >20 mL/kg fluid (OR = 3.074, p = 0.001) were relevant factors to intraoperative hypothermia in infants along with the ASA grade (OR = 4.135, p < 0.001).

Conclusion: The incidence of intraoperative hypothermia was still high, especially in neonates, with a few detrimental complications. Neonates and infants each have their different risk factors associated with intraoperative hypothermia, but younger age, lower weight, longer surgery time, received more fluid, and no prewarming management were the common risk factors.

Keywords: infant; intraoperative hypothermia; neonate; perioperative hypothermia; pre-warming; thermal management.

Grants and funding

This work was supported by the National Natural Science Foundation of China (grant number 81901989) (DL), the Natural Science Foundation of Zhejiang Province (grant number LY21H150005) (DL), the Foundation for The Top-Notch Youth Talent Cultivation Project of Independent Design Project of the National Clinical Research Center for Child Health (grant number Q21B0007) (DL), the Special Fund for the Incubation of Young Clinical Scientist, and The Children's Hospital of Zhejiang University School of Medicine (grant number CHZJU2022YS002) (DL).