CHOC Surgical NICU Reduces Post-Op Hypothermia in Infants

Consistent, standardized efforts across several disciplines helped CHOC Children’s reduce rates of post-operative hypothermia in neonates by nearly 88 percent, results of a quality improvement project show.

Staff decreased the number of babies who returned to the Surgical Neonatal Intensive Care Unit with body temperatures below 36 degrees Celsius from 10.7 percent to 1.3 percent following surgeries between September 2014 and August 2015.

Due to high body surface area, infants undergoing surgery are at risk for hypothermia, especially premature infants with decreased subcutaneous and brown fat. Hypothermia-induced vasoconstriction can lead to impaired wound healing, surgical site infections, impaired coagulation and decreased drug metabolisms, which can collectively increase perioperative morbidity, said Dr. Irfan Ahmad, co-director of the unit.

Though CHOC’s baseline figure was well below the national average rate of 15.6 percent, reducing post-operative hypothermia rates wasmock-surgery-1 identified as an area for quality improvement for the Surgical NICU and staff set out to reduce rates by half, Dr. Ahmad said.

Involving a cross-disciplinary team including nurses, neonatologists, surgeons and anesthesiologists, the project tracked 76 patients. Because infants can be at risk for hypothermia before surgery, intra-operatively and post-operatively, their temperatures were tracked during each operative stage. Staff were then able to identify problem areas and make improvements over each quarter.

Dr. Ahmad attributed the success to consistently implementing measures such as ensuring patients wore hats and blankets while headed to the operating room; pre-warming transport isolettes before placing babies inside; and using intra-operative heating devices during procedures.

Dr. Ahmad presented this data earlier this month to a quality congress held by the Vermont Oxford Network, a nonprofit, voluntary collaboration of health care professionals dedicated to the quality and safety of medical care for newborns and their families.

CHOC established its Surgical NICU in October 2013, and remains one of a handful of hospitals nationwide to cohort infants needing and recovering from surgery in a dedicated space.

Surgical NICU patients receive care from a multidisciplimock-surgery-4nary team that includes neonatologists, surgeons and many other clinicians. The surgical NICU team cares for patients jointly, discussing the cases as a group and forming a treatment plan that often calls for the expertise of other specialties.

Patients and families are a key component of the surgical NICU care team, collaborating and partnering with clinicians on every stage of the patient’s care.

The Surgical NICU rounds out CHOC’s expansive suite of services for neonates, including a main NICU; the Small Baby Unit, where infants with extremely low birth weights receive coordinated care; the Neurocritical NICU, where babies with neurological problems are cohorted; and the Cardiac NICU, which provides comprehensive care for neonates with congenital heart defects.

Learn more about CHOC’s neonatal services.

In the Spotlight: CHOC Children’s Specialists Pediatric Surgery

“I would never live in a community that doesn’t have a children’s hospital,” says Dr. Mustafa Kabeer, a CHOC Children’s Specialists pediatric surgeon.

Dr. Kabeer and his three partners – all fathers – firmly believe that ill or injured children require the clinical expertise and compassionate, family-centered care unique to pediatric facilities, like CHOC Children’s.

“Kids aren’t small adults.  From tiny newborns to adult-sized teens, each pediatric patient deserves access to the technology, environment and people that can only be found at a children’s hospital.  Here at CHOC, everything we do – each and every day – is focused on children.  We deliver a high level of care in a friendly setting that promotes collaboration among staff and families,” explains Dr. Kabeer. 

Philosophy of Caring
Together, Dr. Kabeer and his partners, Dr. David Gibbs, Dr. Troy Reyna and Dr. Saeed Awan, abide by a philosophy of care that engenders trust between them and their patients and families. More specifically, they treat their patients like they’d want their own children treated.  Similarly, they treat the parents the way they’d want to be treated.

“We encourage parents to come to us with questions so they can learn as much as possible.  As parents, we would do the same thing if we were in their shoes. They need to do whatever they can to feel like they are being good parents, and we want to partner with them in that effort.  We have the same goal:  getting their kids better,” says Dr. Gibbs.

This commitment is extended to referring physicians.

“Physicians in the community should always feel comfortable contacting us.  We answer their calls directly and get their patients seen promptly.  With telemedicine and additional technological advances, we’re always exploring ways to extend our reach into the community,” says Dr. Reyna. 

Scope of Services
In addition to performing the more common surgeries, such as hernia repair, the group offers minimally invasive surgery, the Nuss procedure (for the repair of Pectus Excavatum), robotic surgery and thoracic surgery.  With the addition of Dr. Reyna, approximately two years ago, and Dr. Awan, about eight months ago, CHOC Children’s Specialists Pediatric Surgery has increased the scope of clinical activities, performing an increasing number of thoracic surgeries and treating more cases of inflammatory bowel disease, for example.

“One of the reasons my colleagues and I chose this specialty is the breadth and depth of our field.  We completed one of the longest pathways in the U.S. medical system to become pediatric surgeons.  This training prepared us to operate in a number of areas, from the neck to the pelvic region.  And these are the areas in which we have performed thousands of surgeries throughout our years of practice.  As a group, we bring this experience – and the rigorous training it took to get here – to our patients and their families,” says Dr. Awan.

Commitment to CHOC
As advocates for their patients and families, as well as the broader medical community, the pediatric surgeons are actively involved at the hospital.

Dr. Gibbs is president of the medical staff and the interim medical director of pediatric trauma. 
Dr. Kabeer has served on the CHOC Children’s board of directors and currently serves as secretary/treasurer of the Pediatric Subspecialty Faculty, Inc. board of directors.  All four physicians are active on various committees and in resident training.  All are involved in CHOC’s surgical neonatal intensive care unit, which they created in partnership with the hospital’s neonatology division.

“We couldn’t imagine being the kind of physicians we strive to be without a deep connection to the hospital.  It’s been very rewarding to be a part of CHOC’s recent evolution, which gives us a greater ability to care for our kids,” says Dr. Kabeer.

With a primary office in Orange, CHOC Children’s Specialists Pediatric Surgery has offices in Corona, Mission Viejo and Newport Beach. To refer a patient, please call 714-364-4050.