Infants and newborns have a large surface area to volume ratio that allows for greater heat loss. They also lack significant amounts of insulating body fat. If proper precautions are not taken, small infants are at profound risk for heat loss from conduction, convection, evaporation, and radiation. Important thermoregulatory mechanisms are immature and inefficient in the preterm and small infant. For example, brown fat which is produced during the third trimester is vital for thermogenesis. This lack of brown fat in infants born preterm impedes the infant’s innate ability to mount an adequate response to cold stress. In addition, small infants have a limited or absent ability to shiver. Since infants have immature thermoregulation, close attention to maintaining euthermia should be an essential component in the care of the postoperative patient.

The Joint Commission estimates that 80 % of serious medical errors involve miscommunication during care transitions. Miscommunication was the leading root cause of sentinel events reported to the commission between 1995 and 2006. The majority of avoidable adverse events are due to the lack of effective communication. Recent data suggests that standardization of the postoperative handoff process of children undergoing surgery improves outcomes.

Using the acronym SHARE, transitions can become more efficient, informative and safe.