Efficacy of Perioperative and Intraoperative Warming for Pediatric Neurosurgical Patients

Introduction: Hypothermia, defined as having a core body temperature below 36°C, remains a significant risk factor for pediatric patients receiving surgery. Studies have identified adverse postoperative outcomes attributed to preoperative and intraoperative hypothermia, including prolonged hospitalization, immunodeficiency, and increased transfusion volumes. Few studies have explored hypothermia prevention and related outcomes through warming protocols in pediatric neurosurgical procedures.

Methods: This systematic review investigated whether preoperative and intraoperative warming protocols reduce hypothermia severity and improve outcomes for pediatric patients undergoing neurosurgical procedures, compared with patients who only receive standard of care protocols. Publications between 2012 and 2023 were extracted from PubMed, Embase, and Scopus databases. Screening based on inclusion/exclusion criteria and search terms produced 572 studies. Of these, 37 were selected for full-text review, 7 were further evaluated, and 3 fully met our search criteria.

Results: Bleethe et al. implemented a perioperative temperature-management protocol in a sample of 119 patients undergoing craniosynostosis. The warming intervention showed a significant decrease in transfusion rates. Ducis et al. compared 150 pediatric patients on an intraoperative warming protocol to 12 control patients. There was a statistically significant increase in body temperature and decrease in severity of hypothermia after implementation of their warming protocol. Findings from Mutchnick et al. showed a significant difference in mean temperatures between warming and control groups of 120 total patients, but thermodynamic trends between groups were similar.

Conclusion : Although many studies demonstrated a correlation between warming protocols and a reduction in hypothermic consequences, selection was sparse due to limited studies selectively evaluating protocols in a pediatric neurosurgical context. Some studies used multiple protocols to reduce hypothermic outcomes while other studies were not exclusive to pediatric neurosurgical procedures. This review highlights an apparent lack of literature regarding the use of thermo-modulation in pediatric neurosurgery. Additional research on warming protocols in other surgical modalities will be beneficial.