Preventing Perioperative Hypothermia in Neonatal Surgical Patients: A Phased Quality Improvement Initiative within the Wake Up Safe Collaborative.

Background: 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. Problem: A review of prior cases at our institution demonstrated that only 50% of neonates returned from surgery normothermic. Methods: 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. Interventions: Focused on standardizing preparation, clarifying team roles, enhancing intraoperative vigilance, and improving temperature measurement accuracy. Results: 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%. Conclusions: 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.