Neonatal Hypothermia
A recent survey cited in this article demonstrated that ED physicians have found a wide variety of significant pathologies in infants <90 days presenting to the ED with hypothermia. We all know hypothermia carries a risk of SBI/HSV and that work up has been pretty well standardized, so this study looked at what additional pathologies have been identified in babies with hypothermia.
What'd they do? Retrospective, multicenter review looking at neonates <90 days presenting to the ED with reported hypothermia (from home, any method of temperature taking) as well as those found to be hypothermic upon arrival to the ED. Hypothermia defined as <36C
What'd they find? 998 babies met inclusion criteria. Notably, any baby with a chronic medical problem or who was found to be febrile at all during their hospitalization was excluded. "Significant pathology" was defined as anything requiring hospitalization for care, evaluation or monitoring, and again this excluded babies admitted for phototherapy and those admitted simply to monitor the temperature.
Bottom Line: Never trust a neonate, especially when they are hypothermic. Work up the infectious etiologies as per the standardized recommendations, but keep your differential BROAD.
What'd they do? Retrospective, multicenter review looking at neonates <90 days presenting to the ED with reported hypothermia (from home, any method of temperature taking) as well as those found to be hypothermic upon arrival to the ED. Hypothermia defined as <36C
What'd they find? 998 babies met inclusion criteria. Notably, any baby with a chronic medical problem or who was found to be febrile at all during their hospitalization was excluded. "Significant pathology" was defined as anything requiring hospitalization for care, evaluation or monitoring, and again this excluded babies admitted for phototherapy and those admitted simply to monitor the temperature.
- In total, 32% had a significant pathology
- 4% had an SBI/HSV; meaning the remaining 28% were found to have some other pathology that required hospitalization
- The most common "other" pathologies identified included growth faltering (6%), viral bronchiolitis (4.6%), acute respiratory distress/failure (3%), apnea (1.7%), and congenital heart defects (1.3%). Other critical neurologic, cardiac, gastrointestinal and additional pathologies were also identified (ICH, botulism, Adrenal insufficiency and hypothyroidism, to name a few).
- Older age (>29 days), ill appearance, repeated temperature instability and abnormal WBCs were all associated with finding "significant pathology" as well
Bottom Line: Never trust a neonate, especially when they are hypothermic. Work up the infectious etiologies as per the standardized recommendations, but keep your differential BROAD.
