Risk Of Hypothermia Research Articles

Development and internal validation of an algorithm to predict intraoperative risk of inadvertent hypothermia based on preoperative data

Intraoperative hypothermia increases perioperative morbidity and identifying patients at risk preoperatively is challenging. The aim of this study was to develop and internally validate prediction models for intraoperative hypothermia occurring despite active warming and to implement the algorithm in an online risk estimation tool. The final dataset included 36,371 surgery cases between September 2013 and May 2019 at the Vienna General Hospital. The primary outcome was minimum temperature measured during surgery. Preoperative data, initial vital signs measured before induction of anesthesia, and known comorbidities recorded in the preanesthetic clinic (PAC) were available, and the final predictors were selected by forward selection and backward elimination. Three models with different levels of information were developed and their predictive performance for minimum temperature below 36 °C and 35.5 °C was assessed using discrimination and calibration. Moderate hypothermia (below 35.5 °C) was observed in 18.2% of cases. The algorithm to predict inadvertent intraoperative hypothermia performed well with concordance statistics of 0.71 (36 °C) and 0.70 (35.5 °C) for the model including data from the preanesthetic clinic. All models were well-calibrated for 36 °C and 35.5 °C. Finally, a web-based implementation of the algorithm was programmed to facilitate the calculation of the probabilistic prediction of a patient’s core temperature to fall below 35.5 °C during surgery. The results indicate that inadvertent intraoperative hypothermia still occurs frequently despite active warming. Additional thermoregulatory measures may be needed to increase the rate of perioperative normothermia. The developed prediction models can support clinical decision-makers in identifying the patients at risk for intraoperative hypothermia and help optimize allocation of additional thermoregulatory interventions.

Nutritional and Functional Properties of Colostrum in Puppies and Kittens.

Simple SummaryThe post-natal period is a crucial time for all animal species. During the course of their first two weeks of life, puppies and kittens face several risks to their health due to their scarce energy storage and weak immune system. Colostrum is the first production of the mammary glands that plays a pivotal role for puppies and kittens. Colostrum is an important source of immunoglobulins and key nutrients such as lipids and carbohydrates, which are fundamental for the health of newborns. Puppies and kittens must ingest a sufficient amount of colostrum within a few hours of birth to ensure their survival. On the other hand, there are some particular compounds that are not strictly essential, but their presence may play an important role in nutrition and health. As there are no recent studies on companion animals, we have reported published articles describing animal studies in different species to review the nutrition of newborn mammals, with particular emphasis on companion animals.The present review aims toward a better understanding of the nutrition of newborn puppies and kittens. The post-natal period is very sensitive in dogs and cats, as in other animal species. During the first two weeks of life, puppies and kittens are at high risk of dehydration, hypothermia, and hypoglycemia, as well as infectious diseases as they start to acquire the physiological functions of the adult. Neonatal hepatic glycogen storage is low, and newborns depend on colostrum intake to survive. Colostrum provides immunoglobulins and other important substances such as lipids and carbohydrates. Immunoglobulins are central to the immunological link that occurs when the mother transfers passive immunity. The mechanism of transfer varies among mammalian species, but in this review, we focused our attention on dogs and cats. Furthermore, there are components of colostrum which, although their presence is not absolutely necessary, play an important role in nutrition. These components have received considerable interest because of their presumed safety and potential nutritional and therapeutic effects both in humans and animals; however, unfortunately, there are few recent studies in companion animals. Here, we have gathered the published articles that describe studies involving different species of animals, emphasizing companion animals. In particular, the purpose of this narrative of the nutritional and functional proprieties of queens’ and bitches’ colostrum.

Full title: The prevalence of and predictors for perioperative hypothermia in postanaesthesia care unit.

Hypothermia is a common clinical issue during the perioperative period. The patients with perioperative inadvertent hypothermia are associated with higher risk of postoperative complications and higher hospitalisation costs. The aim of this study is to explore the prevalence of and predictors for hypothermia in patients entering postanaesthesia care unit. Retrospective cohort study. A rigorous retrospective cohort study was conducted according to the STROBE reporting checklist. A total of 7216 patients were enrolled in this study. The perioperative variables potentially related to hypothermia were collected. Univariate analysis and multivariate logistic regression analysis were performed to investigate the contributing factors. The overall prevalence of inadvertent hypothermia in postanaesthesia care unit was 21.3% (n=1505). The multivariate logistic regression analysis showed that age >65 (OR=1.561, 95% CI 1.371-1.778, p<.001), non-supine position [lateral decubitus position (OR=1.341, 95% CI 1.133-1.586, p=.001), lithotomy position (OR=1.639, 95% CI 1.295-2.075, p<.001)], non-superficial surgery (OR=2.195, 95% CI 1.566-3.077, p<.001), non-open surgery [laparoscopic surgery (OR=1.205, 95% CI 1.020-1.423, p=.029), endoscopic surgery (OR=1.430, 95%CI 1.084-1.887, p=.011)], the volume of intravenous infusion fluid >1000ml (OR=1.814, 95% CI 1.500-2.194, p<.001), blood transfusion (OR=1.552, 95% CI 1.159-2.078, p=.003), operation performed in the summer or fall (OR=1.874, 95%CI 1.656-2.122, p<.001) and use of dexmedetomidine (OR=1.147, 95%CI 1.015-1.296, p=.028) were associated with increased risk of hypothermia. In contrast, our finding showed that body mass index ≥25kg/m2 (OR=0.556, 95%CI 0.491-0.630, p<.001), higher baseline body temperature (OR=0.641, 95%CI 0.541-0.761, p<.001) and duration of fasting ≥18h (OR=0.487, 95%CI 0.345-0.689, p<.001) were associated with decreased risk of hypothermia. Compared with non-hypothermic patients, patients with hypothermia were associated with prolonged length of hospital days (5 vs. 4days, p<.001). For patients admitted to postanaesthesia care unit after elective procedures, old age, non-supine position, non-open surgery, non-superficial surgery, large volume of intravenous infusion fluid, dexmedetomidine, blood transfusion and Summer or Fall operative season were associated with increased risk of hypothermia, whereas high body mass index, high baseline body temperature and long fasting duration were associated with decreased risk of hypothermia. The outcomes of this study will raise the concerns of perioperative care team on hypothermia in surgical patients. Measures should be taken to improve perioperative hypothermia and clinical outcome.

PENGEMBANGAN SELIMUT EMERGENCY STRETCHER BLANKET SEBAGAI UPAYA PENCEGAHAN HIPOTERMIA PADA KORBAN TRAUMA

Emergency Stretcher Blanket is an innovation blanket product that was modified for victims to be transported using a stretcher from the scene to the ambulance or hospital. The function of the Emergency Stretcher Blanket product is to maintain the victim's body temperature remains optimal and prevent the risk of hypothermia during the victim's transportation process. The purpose of this research is to identify the development process and identify the feasibility of the Emergency Stretcher Blanket product. This study used Research and Development design with adopted ADDIE development model which consists of five stages including analysis, design, development, implementation and evaluation. This research was conducted in Gedog Village, Sananwetan District, Blitar City with 7 respondents consisting of 6 KELTANA cadres and 1 expert validator. The results of this study indicate that the Emergency Stretcher Blanket product meets the appropriate criteria to be used based on the assessment of expert validators and respondents. It is expected that the Emergency Stretcher Blanket product can help KELTANA Gedog cadres as an alternative use option to facilitate the evacuation of victims and prevent hypothermia in trauma victims.

RISPERIDONE-INDUCED MODERATE CENTRAL HYPOTHERMIA

TOPIC: Critical Care TYPE: Medical Student/Resident Case Reports INTRODUCTION: Risperidone is a second-generation atypical antipsychotic medication (APD) commonly used to treat schizophrenia and bipolar disorder. An infrequent dangerous side effect of APDs is hypothermia, defined as a core body temperature < 35 Celsius (C) [1]. CASE PRESENTATION: A 61-year-old male with hypertension, epilepsy, and schizophrenia was transferred to the emergency department for bilateral lower extremity weakness and slow speech for two days. Medications included carbamazepine and risperidone. He denied being outside in the cold and stated he has a heater at home. A week prior, at a follow-up with his primary physician, his oral temperature was 35.5C. A clinical exam revealed dysphasia and right lower leg weakness. Core rectal temperature was 29.1C, indicating moderate hypothermia. Computed tomography of the head and neck with contrast displayed no acute intracranial abnormality. Blood work revealed a normal thyroid-stimulating hormone, cardiac enzymes, and lactic acid. Urinalysis was negative for infection. Chest x-ray showed no acute abnormalities. Carbamazepine level was in the therapeutic range. In the intensive care unit, he was given warmed intravenous fluids and placed on an external warmer with constant temperature monitoring. Due to central hypothermia concerns, risperidone was held, and external warming was applied. Gradually, core temperature increased to 36.5C over the next 14 hours. He had no signs of infection or metabolic derangements to increase his hypothermia risk. He improved quickly and was downgraded to the medical floor. DISCUSSION: Experimental animal model studies reveal a dose-dependent decline in temperature with risperidone [2]. The exact incidence is higher than reported medical literature based on reports submitted to Food and Drug Administration. Mild hypothermia was common and moderate hypothermia was rare after few years of therapy [3]. Mild hypothermia symptoms are inconspicuous and odd, like apathy, confusion, shivering, or hunger, and are often missed [1]. Clinical thermometers fail to register a temperature < than 34.4C. The risk is more in men and patients with schizophrenia and bipolar disorder. Risk factors such as age > 70 years, other APDs, and organic diseases amplify it [3]. APDs are highly antagonistic at serotonin receptors (5-HT2a) than dopamine (D2) and a2 adrenergic receptors. 5-HT2a and a2 receptors act to increase core temperature while D2 acts to decrease it [3]. APD use leads to an imbalance promoting lower core temperature. Monitoring temperature is essential at APDs initiation and dosage changes. Consideration of other medical comorbidities is a must. CONCLUSIONS: APDs induced moderate central hypothermia is a rare, reversible cause. Failure to recognize it by critical care providers can be fatal. REFERENCE #1: Polderman KH. Mechanisms of action, physiological effects, and complications of hypothermia. Crit Care Med. 2009;37(7 Suppl):S186-202 REFERENCE #2: Oerther S, Ahlenius S. Atypical antipsychotics and dopamine D(1) receptor agonism: an in vivo experimental study using core temperature measurements in the rat. J Pharmacol Exp Ther. 2000;292(2):731-736. REFERENCE #3: : Szota AM, Araszkiewicz AS. The risk factors, frequency and diagnosis of atypical antipsychotic drug-induced hypothermia: practical advice for doctors. Int Clin Psychopharmacol. 2019;34(1):1-8. DISCLOSURES: No relevant relationships by Dennis Chairman, source=Web Response No relevant relationships by Sahithi Katragadda, source=Web Response No relevant relationships by Parth Patel, source=Web Response No relevant relationships by Tarang Patel, source=Web Response No relevant relationships by SACHIN PATIL, source=Web Response

Characteristics of antipsychotic drug-induced hypothermia in psychogeriatric inpatients.

Hypothermia is a potentially lethal adverse reaction to typical and atypical antipsychotic drugs (APD). Among predisposing factors are advanced age and comorbid somatic diseases. The aim of this study was to assess the incidence of hypothermia and quantify risk factors. Charts of N=3002 psychogeriatric inpatients were screened for incidence of hypothermia (body core temperature <35.0°C). The frequency of hypothermia was compared between patients treated with versus without APD and, within the sample of APD-treated patients, for (1) specific APD, (2) sex, (3) main diagnosis, and (4) age. N=54 cases (2.6%) of hypothermia occurred in APD-treated patients and 12 cases (1.3%) in non-APD-treated patients (p=0.024). In APD-treated patients, only male sex (p=0.038) and pipamperone were associated with a higher incidence of hypothermia (p=0.0017). Whereas the main diagnosis delirium showed a trend to significance, age did not correlate with hypothermia. Medication with pipamperone was associated with an increased risk of hypothermia. The advanced age of our sample might as well explain the high incidence of hypothermia within our sample and the failure to detect high age as a risk factor due to a ceiling effect.

Delivery room thermal care interventions in preterm neonates.

Abiramalatha T, Ramaswamy VV, Bandyopadhyay T, Pullattayil AK, Thanigainathan S, Trevisanuto D, Roehr CC. Delivery Room Interventions for Hypothermia in Preterm Neonates: A Systematic Review and Network Meta-analysis. JAMA Pediatr. 2021 May 24:e210775. 10.1001/jamapediatrics.2021.0775. Epub ahead of print. PMID: 34028513; PMCID: PMC8145154. Preterm neonates are at increased risk for hypothermia after birth which is an independent predictor for neonatal mortality and morbidity.1, 2 Maintaining normal temperature is a key initial step in stabilisation of the newborn at birth.3 Several interventions to prevent hypothermia in the delivery room have been studied either solely or in combinations.4-7 The neonatal life support task force suggested using a combination of different interventions to prevent hypothermia on neonatal admission to the NICU.3 However, this suggestion was based on relatively old evidence with weak recommendations and very low certainty. This network meta-analysis was conducted on 34 randomised and quasi-randomised controlled trials including 3688 preterm, ≤36 weeks gestation and infants aiming to identify thermal care intervention in the delivery room that can best reduce neonatal hypothermia and improve clinical outcomes. The researchers compared eight interventions to routine care and found that most of the interventions were associated with higher core body temperature. They found that plastic bag or wrap alone, thermal mattress, and plastic bag or wrap with heated humidified gas were associated with reduced risk of moderate to severe hypothermia compared with routine care. The SUCRA analysis showed that the combination of plastic bag or wrap with a thermal mattress was the best intervention to improve core body temperature at admission, but direct evidence from pairwise comparisons indicated that this combination increases the risk of hyperthermia. In sensitivity analyses, plastic bag and plastic wrap were equally good at maintaining core body temperature, the effect of interventions in improving temperature was consistent among preterm infants ≤30 weeks gestation, and drying did not make a difference compared to no drying before the application of plastic bag or wrap. Authors found that the use of a plastic bag or wrap with heated humidified gas was associated with reduced risk of major brain injury and a plastic bag or wrap with a plastic cap was associated with lower risk of mortality. Major strengths of this study are the use of network meta-analysis which can inform comparative effectiveness in the presence of multiple interventions, the systematic search strategy, and clinically relevant interventions and outcomes. However, the study is limited by wide differences in the method of temperature measurement between included trials, inability to perform analysis of some secondary outcomes due to data limitation, small sample size of the included trials and low event rates for the primary outcome leading to possible selective reporting and publication bias, and inability to access unpublished data from the included studies.5 Although, the majority of thermal care interventions were associated with better core body temperature and decreased risk of moderate to severe hypothermia at admission or within the first 2 h of life compared with routine care, the certainty of evidence ranged from very low to moderate for the primary and secondary outcomes. Future, adequately powered, randomised controlled trials are needed to determine the best combination of interventions to prevent hypothermia with no risk of hyperthermia and to assess quality improvement bundle of hypothermia preventive measures to assess the individual benefit for each newborn. https://ebneo.org/preterm-thermal-care None.

Perioperative Hypothermia-A Narrative Review.

Unintentional hypothermia (core temperature < 36 °C) is a common side effect in patients undergoing surgery. Several patient-centred and external factors, e.g., drugs, comorbidities, trauma, environmental temperature, type of anaesthesia, as well as extent and duration of surgery, influence core temperature. Perioperative hypothermia has negative effects on coagulation, blood loss and transfusion requirements, metabolization of drugs, surgical site infections, and discharge from the post-anaesthesia care unit. Therefore, active temperature management is required in the pre-, intra-, and postoperative period to diminish the risks of perioperative hypothermia. Temperature measurement should be done with accurate and continuous probes. Perioperative temperature management includes a bundle of warming tools adapted to individual needs and local circumstances. Warming blankets and mattresses as well as the administration of properly warmed infusions via dedicated devices are important for this purpose. Temperature management should follow checklists and be individualized to the patient’s requirements and the local possibilities.

The Effect of Intraoperative Body Temperature on Postoperative Nausea and Vomiting in Pediatric Patients

PurposePediatric patients are at greater risk for both perioperative hypothermia and postoperative nausea and vomiting (PONV). The primary aim of this study was to investigate whether there is a relationship between intraoperative body temperature and PONV in children undergoing anesthesia. The secondary aim was to investigate the relationship between PONV and intraoperative fentanyl use, age and duration of operation. DesignA prospective cohort study MethodsThe study included 80 children who were undergoing lower abdominal surgery. Body temperature was monitored after routine preoperative preparation and standard induction. Analgesic and antiemetic requirements and the presence of nausea and vomiting were assessed postoperatively on the 30th minute and the 6th, 12th and 24th hour. FindingsThe children with or without PONV were compared. At the postoperative 6th hour, the incidence of nausea was statistically significant in the children with a mean body temperature below 36°C (P = 0.044; P < 0.05). The mean duration of the surgery was statistically significant longer in the children with PONV (P = 0.001; P = 0.004; P <0.05). Mean body temperature was not statistically significant when comparing children with and without vomiting(P > 0.05). ConclusionWhile a body temperature below 36°C increases the incidence of postoperative nausea, it does not cause an increase in the incidence of vomiting. A long operation time in pediatric patients causes an increase in the incidence of PONV. Although not statistically significant, PONV is encountered more than twice as much in patients receiving intraoperative fentanyl administration.

Analisis Pengetahuan dan Keterampilan Tenaga Kesehatan tentang Perawatan Bayi dengan Metode Kangarro Mother Care (KMC)

Background: Low birth weight (LBW) because they do not have a complete temperature to deal with environmental changes in the high temperature intra uterine and extra uterine environment, because cold temperatures can affect. The KMC method can reduce the risk of hypothermia because the heat from the mother's body provides heat to the baby's body by direct skin-to-skin contact and greatly facilitates the mother in giving breast milk (ASI) to the baby, strengthens the affectionate relationship between mother and baby and reduces time stay in hospital. Research (Uwaezuoke, 2017) on the effectiveness of the kangaroo method on LBW, shows that the kangaroo method can strengthen the relationship between mother and baby as well as a positive effect on infant weight. Babies born with LBW are caused by the process of losing body heat through: evaporation, radiation, conduction and convection, because of subcutaneous fat, brown fat, and less glycogen stray sites (Merenstein &amp; Gardner, 2002).Methods: This research has used quantitative research with a descriptive approach. Focus on nurses in the Perinatology nursing room, HNGV, Dili, Timor-Leste in March 2019.Results: Using the criteria for the KMC method on newborns treated in the HNGV neonatology inpatient ward, analysis of 38 indicators for health workers who provide services to infants. The results of the study show that answering all the criteria is not correct with a minimum number of 3% and a maximum of 91%. On another aspect they need to answer that all the criteria are correct with the results showing a minimum of 6% and a maximum of 100%.Conclusion: Hospitals (neonatology units) need to regularly hold special training related to KMC for health workers to improve and expand their knowledge.

Nursing diagnoses of preterm infants in the neonatal intensive care unit: A cross sectional study

Background and aimNursing diagnoses help nurses in effective intervention to get the best results. This study aimed to identify common nursing diagnoses of some of domains of NANDA taxonomy in premature infants admitted to the neonatal intensive care unit. MethodIn this descriptive cross-sectional study, a researcher-made instrument was used. The instrument contained two sections on maternal and neonatal demographic information and a checklist, extracted from literature, on infant-related nursing diagnoses. After obtaining the necessary permits, 96 infants were evaluated during a six-month period at the neonatal intensive care unit of Taleghani Hospital, according to inclusion criteria, and using the convenience sampling method. Data on each infant was collected and categorized into six domains of NANDA nursing diagnosis taxonomy based on the relevant checklist. ResultsThe most common actual nursing diagnoses included interrupted breastfeeding (00105), ineffective breastfeeding (00104), impaired gas exchange (00030), ineffective airway clearance (00031). The most common risk for nursing diagnoses in the first assessment were risk for infection (00004), risk for injury (00035), risk for delayed development (00112). risk for electrolyte imbalance (00195), risk for unstable blood glucose level (00179), risk for hypothermia (00253), and risk for neonatal jaundice (00230). ConclusionSome of the common nursing diagnoses in some domains of NANDA taxonomy were determined for preterm infants and can help nurses to develop more specialized care plan for this age group.

Using a Plastic Drape to Reduce Hypothermia in Premature Neonates During Peripherally Inserted Central Catheter Placement.

Premature neonates require assisted heating devices for thermoregulation in the neonatal intensive care unit (NICU). Traditional use of a cloth blanket and cloth towels during peripherally inserted central catheter (PICC) placement may hinder heat transfer from the assisted heating mechanisms, increasing the risk for neonatal hypothermia. This quality improvement project's goal was to reduce the hypothermia rate in very low birth-weight (VLBW) neonates by replacing cloth blanket/towels with a plastic drape during PICC placement. The FOCUS-PDSA method was used to implement the intervention (plastic drape) over 3 months, during 58 PICC procedures in a level 3 NICU. A pre-/posttest design was used to evaluate the impact of the intervention on hypothermia rates compared with a baseline cloth group and a concurrent cloth cohort. After the 3-month implementation period, the hypothermia rate for the intervention group was lower than that for the baseline cloth group (5.2% and 11.3%, respectively), but this difference was not statistically significant. Post-PICC hypothermia rates were significantly lower for the intervention group than for the concurrent cloth cohort (P = .004). Preliminary evidence demonstrated the plastic drape reduced the hypothermia rate in the NICU for VLBW neonates during PICC placement compared with cloth blanket/towels. A plastic drape shows promise in improving nursing practice by providing improved thermoregulation for premature neonates during PICC placement. Further research is recommended to replicate findings with larger samples of PICC insertions, using a plastic drape in the operating room and other NICU procedures.

Efficacy of an Infrared Radiator for Hypothermia Prevention in a Simulated Setup of Entrapped Vehicle Accident Victims

BackgroundProlonged extrication of entrapped patients after road traffic accidents increases the risk of sustained hypothermia. Accident-related hypothermia increases mortality in severely injured patients, and prehospital efforts to prevent hypothermia are essential. We evaluated various warming measures regarding their preclinical suitability and efficacy for patient warming, tested in realistically-simulated road traffic accident scenarios under cold ambient conditions in a climate chamber. MethodsThe effects of a chemical warming blanket (CWB), forced-air warming (FAW) device, or infrared radiator (IRR) on the core body and skin surface temperature of a subject previously exposed to a cold environment (5°C for 12 minutes) was recorded via temperature sensors and thermographically, respectively. Physiological parameters such as oxygen saturation, blood pressure, and heart rate were also monitored. ResultsUnder cold environmental conditions, all devices were able to compensate or overcompensate the cooling of body parts directly exposed to the heating measure. In the body areas that were not directly warmed (back, lower extremities), only the CWB limited further cooling. FAW and IR irradiation rapidly and effectively warmed the heat-exposed areas (head and arms). However, both methods – but especially the IRR – led to a noticeably accelerated cooling in body parts not directly exposed to heat (back, legs). ConclusionThe increased mortality associated with hypothermia in severely injured crash victims during prolonged vehicle extrication has intensified efforts to prevent sustained hypothermia. The use of a CWB, FAW or IRR are in principle all suitable for reducing or compensating for heat loss. The ongoing cooling of those body parts not directly exposed to the heat source was interpreted as a steal phenomenon in regional blood flow. However, the practicality and effectiveness of these measures, combined with their logistical requirements, must be evaluated in real extrication scenarios.

Effects of nutritional interventions during pregnancy on birth, child health and development outcomes: A systematic review of evidence from low- and middle-income countries.

Optimal nutrition plays a crucial role in pregnancy. Poor maternal nutrition and maternal obesity has risk factors for serious fetal complications and neonatal outcomes, including intrauterine growth restriction, congenital abnormalities, stillbirth, low birth weight (LBW), preterm birth, fetal macrosomia, increased risk of neonatal infections, neonatal hypothermia, and neonatal death. The prevalence of maternal malnutrition is higher in low- and middle-income countries (LMICs) (10-19%) when compared with high-income countries, with variation by region and by country. Several behavioral interventions, including dietary control and exercise, have been found to reduce the risk of these adverse outcomes. However, none has reviewed dietary interventions to prevent maternal obesity in pregnant women. The review aims to assess the effectiveness of balanced energy protein (BEP) supplementation, food distribution programs (FDPs), and dietary interventions to prevent maternal obesity during pregnancy on birth, child health, and developmental outcomes. We searched Cochrane Controlled Trials Register (CENTRAL), MEDLINE, Embase, CINAHL, and 12 other databases, and trials registers for ongoing studies up until April 2019. We also searched for gray literature from different sources and for citations on Google Scholar and Web of Sciences. We also checked the reference lists of included studies and relevant reviews and contacted the authors of studies for any ongoing and unpublished studies. The search was followed by title/abstract screening, full-text screening and data extraction. We included randomized control trials, and quasi experimental trials to evaluate the impact of nutritional interventions (BEP, FDP, and dietary interventions to prevent maternal obesity) compared to control or standard of care, among healthy pregnant women of any age living in LMICs. Two review authors independently assessed and screened studies for eligibility, extracted data, and assessed quality of the studies included in the review. We conducted a meta-analysis of all reported primary and secondary outcomes. Subgroup analysis and GRADE assessment was performed for all reported primary outcomes. The review included 15 studies, of these, eight were on BEP supplementation, five on FDP, and two on interventions for obesity prevention. BEP supplementation may show a reduction in the rate of stillbirths by 61% (risk ratio [RR], 0.39; 95% CI, 0.19-0.80; three studies, n = 1913; low quality on GRADE), perinatal mortality by 50% (RR, 0.50; 95% CI, 0.30-0.84; one study, n = 1446; low quality on GRADE), LBW infants by 40% (RR, 0.60; 95% CI, 0.41-0.86; three studies, n = 1830; low quality of evidence on GRADE); small for gestational age (SGA) by 29% (RR, 0.71; 95% CI, 0.54-0.94; five studies, n = 1844) and increased birth weight by 107.28 g (mean difference [MD], 107.28 g; 95% CI, 68.51-146.04, eight studies, n = 2190). An increase of 107.28 g of birthweight is clinically significant in the countries where the intervention was provided. BEP supplementation had no effect on miscarriage, neonatal mortality, infant mortality, preterm birth, birth length, and head circumference. FDP may show improvement in mean birth weight by 46 g (MD, 46.00 g; 95% CI, 45.10-46.90, three studies, n = 5272), in birth length by 0.20 cm (MD, 0.20 cm; 95% CI, 0.20-0.20, three studies, n = 5272), and reduction in stunting by 18% (RR, 0.82; 95% CI, 0.71-0.94; two studies; n = 4166), and wasting by 13% (RR, 0.87; 95% CI, 0.78-0.97; two studies, n = 3883). There was no effect of FDP on miscarriage, maternal mortality, perinatal mortality, neonatal mortality, infant mortality, preterm birth, LBW, SGA, head circumference, and underweight babies. Studies on interventions for obesity prevention among pregnant women failed to report on the primary outcomes. The studies showed a 195.57 g reduction in mean birth weight (MD, -195.57 g, 95% CI, -349.46 to -41.68, two studies, n = 180), and had no effect on birth length, and macrosomia. Our review highlights improvement in maternal, birth, and child outcomes through BEP supplementation and FDP during pregnancy. But, due to the small number of included studies and low quality of evidence, we are uncertain of the effect of BEP supplementation, FDP and dietary interventions for prevention of obesity on maternal, and child outcomes. Thus, further good quality research is recommended to assess the effect of these interventions on maternal, child and developmental outcomes.

Target Temperature Control in Patients with Burns

Severe burns lead to a persistent hypermetabolic response of the organism with significantly increased resting energy turnover, multi-organ dysfunction, muscle breakdown and increased risk of infection. Elevated core and skin temperatures are characteristic. A further increase in the metabolic rate can be triggered by heat losses, for which these patients are particularly predisposed due to high heat dissipation via evaporation of moisture and impairment of the thermoregulatory and insulating properties of the burnt skin. This is especially true in all treatment situations with exposure to large, uncovered skin surfaces, such as primary care, dressing changes in the intensive care unit and surgery with extensive sterile operating field. It has been shown that hypothermia is associated with numerous risks for the burn patient. Consistent heat management with measurement of the core body temperature and application of external and internal heat protection measures is recommended. Traditionally, an increase in room temperature is used here. However, this effective measure is limited by the resilience of the intensive care practitioners and the surgeons. To avoid perioperative hypothermia, strict surgical planning with limitation of the duration of surgery and close intraoperative communication about the risk of hypothermia are of particular importance.The differentiation between accepted temperature increase and infectious fever is often only possible by the inclusion of further examination findings. The criterion for sepsis is a temperature above 39 °C or below 36.5 °C.

Bed sharing versus no bed sharing for healthy term neonates.

There isgreat global variation in the sleeping arrangements for healthy newborn infants. Bed sharingis a type of sleeping practice in which the sleeping surface (e.g. bed, couch or armchair, or some other sleeping surface) is shared between the infant and another person. The possible physiological benefits include better oxygen and cardiopulmonary stability, fewer crying episodes, less risk of hypothermia, and a longer duration of breastfeeding. On the other hand, the most important harmful effect of bed sharing is that it may increase the risk of sudden infant death syndrome (SIDS). Studies have found conflicting evidence regarding the safety and efficacy of bed sharing during infancy. To evaluate the efficacy and safety of bed sharing, started during the neonatal period, on breastfeeding status (exclusive and total duration of breastfeeding), incidence of SIDS, rates of hypothermia, neonatal and infant mortality, and long-term neurodevelopmental outcomes. We used the standard search strategy of Cochrane Neonatal to search the Cochrane Central Register of Controlled Trials (CENTRAL 2020, Issue 7) in the Cochrane Library; MEDLINE via PubMed (1966 to 23 July 2020), CINAHL (1982 to 23 July 2020), and LILACS (1980 to23 July 2020). We also searched clinical trials databases, and the reference lists of retrieved articles, for randomised controlled trials (RCTs) and quasi-RCTS. We planned to include RCTs or quasi-RCTs (including cluster-randomised trials) that included term neonates initiated on bed sharingwithin 24 hours of birth (and continuing to bed share with the mother in the first four weeks of life, followed by a variable time period thereafter), and compared them to a 'no bed sharing' group. We used standard methodological procedures as recommended by Cochrane. We planned to use the GRADE approach to assess the certainty of evidence. Our search strategy yielded 6231 records. After removal of duplicate records, we screened 2745 records by title and abstract. We excluded 2739 records that did not match our inclusion criteria. We obtained six full-text studies for assessment. These six studies did not meet the eligibility criteria and were excluded. We did not find any studies that met our inclusion criteria. There is a need for RCTs on bed sharing in healthy term neonates that directly assess efficacy (i.e. studies in a controlled setting, like hospital) or effectiveness (i.e. studies conducted in community or home settings) and safety. Future studies should assess outcomes such asbreastfeeding status and risk of SIDS. They should alsoinclude neonates fromhigh-income countries and low- and middle-income countries, especially those countries wherebed sharing is more prevalent because of cultural practices (e.g. Asian countries).

A digital tool for prevention and management of cold weather injuries\u2014Cold Weather Ensemble Decision Aid (CoWEDA)

This paper describes a Cold Weather Ensemble Decision Aid (CoWEDA) that provides guidance for cold weather injury prevention, mission planning, and clothing selection. CoWEDA incorporates current science from the disciplines of physiology, meteorology, clothing, and computer modeling. The thermal performance of a cold weather ensemble is defined by endurance times, which are the time intervals from initial exposure until the safety limits are reached. These safety limits correspond to conservative temperature thresholds that provide a warning of the approaching onset of frostbite and/or hypothermia. A validated six-cylinder thermoregulatory model is used to predict human thermal responses to cold while wearing different ensembles. The performance metrics, model, and a database of clothing properties were integrated into a user-friendly software application. CoWEDA is the first tool that allows users to build their own ensembles from the clothing menu (i.e., jackets, footwear, and accessories) for each body region (i.e., head, torso, lower body, hands, feet) and view their selections in the context of physiological strain and the operational consequences. Comparison of predicted values to skin and core temperatures, measured during 17 cold exposures ranging from 0 to −40°C, indicated that the accuracy of CoWEDA prediction is acceptable, and most predictions are within measured mean ± SD. CoWEDA predicts the risk of frostbite and hypothermia and ensures that a selected clothing ensemble is appropriate for expected weather conditions and activities. CoWEDA represents a significant enhancement of required clothing insulation (IREQ, ISO 11079) and wind chill index-based guidance for cold weather safety and survival.

Risco de hipotermia perioperatória: revisão integrativa

Objetivo: Identificar a ocorrência e os fatores de risco determinantes para o desenvolvimento do diagnóstico de enfermagem risco de hipotermiaperioperatória. Método: Revisão integrativa, usando o acrônimo PIO (pacientes, intervenção, outcomes/desfecho), em que P=pacientes adultos e idosos;I=cirurgias eletivas; O=fatores de risco associados à hipotermia perioperatória. A revisão foi conduzida e reportada com base no Check-list PreferredReporting Items for Systematic Reviews and Meta-Analyses (PRISMA), seguindo-se as sete etapas propostas pelo método PRISMA. Resultados: A buscagerou 854 artigos, sendo retirados os duplicados e os sem relevância. Após aplicação dos critérios de exclusão, 13 artigos foram submetidos à análise final.Índice de massa corporal baixo, idade avançada e tempo cirúrgico prolongado foram os fatores mais relacionados ao desenvolvimento de hipotermianos pacientes cirúrgicos. O manejo da hipotermia colabora para diminuição dos riscos de eventos adversos cardíacos, complicações infecciosas, sangramentose traz maior conforto para o paciente. Conclusão: O enfermeiro precisa agir antes do quadro hipotérmico se instalar, reconhecendo os fatoresde risco inerentes ao paciente e identificando quais tecnologias do cuidado aplicar.

A standardized protocol to reduce preoperative hypothermia in pediatric spinal fusion surgery: a quality improvement initiative.

Hypothermia in adult surgical patients has been correlated with an increase in the occurrence of surgical site wound infections, increased bleeding, slower recovery from anesthetics, prolonged hospitalization, and increased healthcare costs. Pediatric surgical patients are at potentially increased risk for hypothermia because of their smaller body size, limited stores of subcutaneous fat, and less effective regulatory capacity. This risk is exacerbated during pediatric spinal surgery by lower preoperative temperature, increased surface exposure to cold during induction and positioning, and prolonged surgical procedure times. The purpose of this quality improvement initiative was to reduce the duration of hypothermia for pediatric patients undergoing spine surgery. Demographic and clinical data were collected on 162 patients who underwent spinal deformity surgery between October 1, 2017, and July 31, 2019. Data points included patient age, gender, diagnosis, surgical procedure, and temperature readings throughout different phases of perioperative care. Temperatures were obtained upon arrival to the day of surgery, upon presentation to the operating room, during prone positioning, at incision, and at the end of the procedure. Twelve patients were analyzed prior to implementation of a protocol, while 150 patients composed the post-protocol group. Using descriptive statistics, the authors found that the average body temperature at the time of incision was 34.0°C prior to the adoption of a preoperative warming protocol, and 35.3°C following a preoperative warming protocol (p = 0.001). There were no complications, such as burns, hyperthermia, or arrhythmias, related to preoperative warming of patients. The placement of a warming blanket on the bed prior to patient arrival and actively targeting normothermia reduced the incidence and duration of hypothermia in pediatric patients undergoing spine surgery with no adverse events.

Risk factors for perioperative hypothermia and infectious outcomes in gastroschisis patients

IntroductionPrior data suggest that infants with gastroschisis are at high risk for hypothermia and infectious complications (ICs). This study evaluated the associations between perioperative hypothermia (PH) and ICs in gastroschisis using a multi-institutional cohort. MethodsRetrospective review of infants with gastroschisis who underwent abdominal closure from 2013–2017 was performed at 7 children's hospitals. Any-IC and surgical site infection (SSI) were stratified against the presence or absence of PH, and perioperative characteristics associated with PH and SSI were determined using multivariable logistic regression. ResultsOf 256 gastroschisis neonates, 42% developed PH, with 18% classified as mild hypothermia (35.5–35.9 °C), 10.5% as moderate (35.0–35.4 °C), and 13% severe (<35 °C). There were 82 (32%) ICs with 50 (19.5%) being SSIs. No associations between PH and any-IC (p = 0.7) or SSI (p = 0.98) were found. Pulmonary comorbidities (odds ratio (OR)=3.76, 95%CI:1.42–10, p = 0.008) and primary closure (OR=0.21, 95%CI:0.12–0.39, p<0.001) were associated with PH, while silo placement (OR=2.62, 95%CI:1.1–6.3, p = 0.03) and prosthetic patch (OR=3.42, 95%CI:1.4–8.3, p = 0.007) were associated with SSI on multivariable logistic regression. ConclusionsPrimary abdominal closure and pulmonary comorbidities are associated with PH in gastroschisis, however PH was not associated with increased risk of ICs. Independent risk factors for SSI include silo placement and prosthetic patch closure.