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A measurement method for core temperature must be clinically accurate, precise and should be minimally invasive. Zero-heat-flux (ZHF) temperature measurements have been evaluated in several studies in adults. We assessed the agreement between the 3M Bair Hugger<jats:sup>\u2122<\/jats:sup> temperature measurement sensor (T<jats:sub>ZHF<\/jats:sub>) and esophageal temperature (T<jats:sub>Eso<\/jats:sub>) in children up to and including 6\u00a0years undergoing surgery with general anesthesia. Data were recorded in 5\u00a0min-intervals. We investigated the accuracy of the ZHF sensor overall and in subgroups of different age, ASA classification, and temperature ranges by Bland\u2013Altman comparisons of differences with multiple measurements. Change over time was assessed by a linear mixed model regression. Data were collected in 100 children with a median (1st\u20133rd quartile) age of 1.7 (1\u20133.9) years resulting in 1254 data pairs. Compared to T<jats:sub>Eso<\/jats:sub> (range from 35.3 to 39.3\u00a0\u00b0C; median 37.2\u00a0\u00b0C), T<jats:sub>ZHF<\/jats:sub> resulted in a mean bias of +0.26\u00a0\u00b0C (95% confidence interval +0.22 to +0.29\u00a0\u00b0C; 95% limits of agreement \u22120.11 to +0.62\u00a0\u00b0C). Lin\u2019s concordance correlation coefficient was 0.89. There was no significant or relevant change of temperature over time (0.006\u00a0\u00b0C per hour measurement interval, p\u2009=\u20090.199) and no relevant differences in the subgroups. Due to the mean bias of +0.26\u00a0\u00b0C in T<jats:sub>ZHF<\/jats:sub>, the risk of hypothermia may be underestimated, while the risk of hyperthermia may be overestimated. Nevertheless, because of its high precision, we consider ZHF valuable for intraoperative temperature monitoring in children and infants.<\/jats:p>","DOI":"10.1007\/s10877-020-00609-5","type":"journal-article","created":{"date-parts":[[2020,10,31]],"date-time":"2020-10-31T18:02:45Z","timestamp":1604167365000},"page":"1445-1451","update-policy":"https:\/\/doi.org\/10.1007\/springer_crossmark_policy","source":"Crossref","is-referenced-by-count":14,"title":["Intraoperative zero-heat-flux thermometry overestimates esophageal temperature by 0.26\u00a0\u00b0C: an observational study in 100 infants and young children"],"prefix":"10.1007","volume":"35","author":[{"ORCID":"https:\/\/orcid.org\/0000-0001-6288-7784","authenticated-orcid":false,"given":"Marcus","family":"Nemeth","sequence":"first","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Marijana","family":"Lovric","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-1317-2138","authenticated-orcid":false,"given":"Thomas","family":"Asendorf","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-4013-8755","authenticated-orcid":false,"given":"Anselm","family":"Br\u00e4uer","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-4302-9167","authenticated-orcid":false,"given":"Clemens","family":"Miller","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"297","published-online":{"date-parts":[[2020,10,31]]},"reference":[{"key":"609_CR1","doi-asserted-by":"publisher","first-page":"588","DOI":"10.1111\/pan.13383","volume":"28","author":"K Becke","year":"2018","unstructured":"Becke K, Eich C, H\u00f6hne C, J\u00f6hr M, Machotta A, Schreiber M, S\u00fcmpelmann R. 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Br\u00e4uer is a member of the advisory board of 3M Europe and has received payments from 3M Germany, 3M Europe, 3M Asia Pacific Pte Ltd. for consultancy work.","order":2,"name":"Ethics","group":{"name":"EthicsHeading","label":"Conflict of interest"}},{"value":"Patient data was completely anonymized for publication.","order":3,"name":"Ethics","group":{"name":"EthicsHeading","label":"Consent for publication"}},{"value":"Ethical approval was sought and approved by the local ethics committee (Ethics committee of the University Medical Centre G\u00f6ttingen, No. 25\/1\/19).This study was registered in the German Clinical Trials Register (DRKS-ID: 00016655), day of registration 03\/26\/2019.","order":4,"name":"Ethics","group":{"name":"EthicsHeading","label":"Ethics approval"}},{"value":"Written informed consent was obtained from parents or legal guardians for all patients.","order":5,"name":"Ethics","group":{"name":"EthicsHeading","label":"Informed consent"}}]}}