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BTW…Cold Baby – Does Incidental Infant Hypothermia Warrant Workup?

January 17, 2023

Written by Joshua Campbell

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Well-appearing neonates with incidentally noted hypothermia at a routine visit are at a low risk for serious infection and may not warrant a full sepsis evaluation.

Why does this matter?
Prevalence of serious infection in hypothermic neonates ranges from 2.6% to 2.8% to 4.9%. There is wild practice variation with regard to the workup. Yesterday, we learned there is no specific temperature threshold to go by. Neonates with incidental hypothermia identified by their primary care practitioner and referred to EDs may represent a different population than hypothermic neonates who present directly to the ED. If a hypothermic neonate is not showing signs of systemic infection, does this infant require a full sepsis workup?

Ice is back with a brand new…retrospective study
A retrospective, observational study of all well-appearing neonates (<28 days) who were noted to be hypothermic at a routine PCP visit and referred to this tertiary children’s hospital ED between Jan 2011 and June 2019 were evaluated. 212 patients were included in the study. Of these, 201 were admitted to the hospital and received parenteral antibiotics. 11 patients were discharged home from the ED. There were no positive CSF bacterial cultures or positive CSF PCR tests. Blood cultures grew contaminants in 3 patients. One urine culture grew a contaminant. No true positive blood or urine cultures were found. Only one patient tested positive for rhinovirus on PCR respiratory panel.

My takeaway: This study indicates an important distinction between incidentally noted hypothermia at routine visits and hypothermia with signs of systemic infection. While prospective studies are needed to investigate the utility of the infant hypothermia workup (i.e. inflammatory markers, procalcitonin), this study certainly brings into question whether we should be doing invasive tests for this subset of hypothermic neonates.

Editor’s note: Thank to Don Arnold for bringing this important study to my attention, and congrats to the Vanderbilt team! ~Clay Smith

Jain SB, Anderson T, Mikhail D, Banerjee R, Arnold DH. Serious infections are rare in well-appearing neonates with hypothermia identified incidentally at routine visits. Am J Emerg Med. 2022 Dec 13;65:1-4. doi: 10.1016/j.ajem.2022.12.008. Epub ahead of print.

What are your thoughts?