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A quality improvement project to reduce hypothermia in infants undergoing MRI scanning

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Abstract

Background

Hypothermia prevention strategies during MRI scanning under general anesthesia in infants may pose a challenge due to the MRI scanner’s technical constraints. Previous studies have demonstrated conflicting results related to increase or decrease in post-scan temperatures in children. We noted occurrences of post-scan hypothermia in anesthetized infants despite the use of routine passive warming techniques.

Objective

The aims of our quality improvement project were (a) to identify variables associated with post-scan hypothermia in infants and (b) to develop and implement processes to reduce occurrence of hypothermia in neonatal intensive care unit (NICU) infants undergoing MRI.

Materials and methods

One hundred sixty-four infants undergoing MRI scanning were prospectively audited for post-scan body temperatures. A multidisciplinary team identified potential variables associated with post-scan hypothermia and designed preventative strategies: protocol development, risk factor identification, vigilance and use of a vacuum immobilizer. Another audit was performed, specifically focusing on NICU infants.

Results

In the initial phase, we found that younger age (P = 0.002), lower weight (P = 0.005), lower pre-scan temperature (P < 0.01), primary anesthetic technique with propofol (P < 0.01), advanced airway devices (P = 0.02) and being in the NICU (P < 0.01) were associated with higher odds for developing post-scan decrease in body temperature. Quality improvement processes decreased the occurrence of hypothermia in NICU infants undergoing MRI scanning from 65% to 18% (95% confidence interval for the difference, 26-70%, P < 0.001).

Conclusion

Several variables, including being in the NICU, are associated with a decrease in post-scan temperature in infants undergoing MRI scanning under sedation/general anesthesia. Implementation of strategies to prevent hypothermia in infants may be challenging in the high-risk MRI environment. We were able to minimize this problem in clinical practice by applying quality improvement principles.

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Acknowledgments

Part of this work was presented at the American Society of Anesthesiology Annual Meeting, 2011, in Chicago and at the Vermont Oxford Neonatal Network Meeting, 2013, in Chicago.

This work was supported by the Departments of Anesthesiology and Newborn Medicine, Penn State Hershey Medical Center and Penn State Hershey Children’s Hospital, Hershey, PA. The vacuum immobilizer blanket was purchased from a Children’s Miracle Network grant.

We thank Ruth Gundermann, program manager, Quality and Safety Outcomes, Penn State Children’s Hospital; Dr. Steve Wassner, former chief quality officer and professor of pediatrics, Penn State Children’s Hospital; Jackie Lamendola, quality coordinator, Department of Anesthesiology; Dr. Sara Moseman, former resident; Dr. Diane McCloskey, Department of Anesthesiology research specialist; Jason Hatter, chief MRI technologist, and all of our radiology sedation nurses, for their help with this project. We also thank the faculty of the Pediatric Anesthesia division for all of their help and support. Purchase of the infant immobilizing blanket and the MRI-compatible monitors was made possible by the generosity of the Children’s Miracle Network. We thank Dr. Mathur and his team at Washington University School of Medicine, St. Louis Children’s Hospital, for permission to adapt the guidelines for use of the immobilizer device.

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Authors and Affiliations

  1. Department of Anesthesiology, H187, Penn State Hershey Medical Center and Penn State Hershey Children’s Hospital, 500 University Drive, Hershey, PA, 17033, USA

    Priti G. Dalal, Uma Parekh, Padmani Dhar & Patrick M. McQuillan

  2. Division of Newborn Medicine, Penn State Children’s Hospital, Hershey, PA, USA

    Janelle Porath & Dennis Mujsce

  3. Department of Public Health Sciences, Penn State College of Medicine, Hershey, PA, USA

    Ming Wang

  4. Department of Radiology, Penn State Hershey Medical Center, Hershey, PA, USA

    Michael Hulse

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  1. Priti G. Dalal
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  2. Janelle Porath
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Correspondence to Priti G. Dalal.

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Dalal, P.G., Porath, J., Parekh, U. et al. A quality improvement project to reduce hypothermia in infants undergoing MRI scanning. Pediatr Radiol 46, 1187–1198 (2016). https://doi.org/10.1007/s00247-016-3592-0

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  • DOI: https://doi.org/10.1007/s00247-016-3592-0

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