Clinical practice guidelines are well described and useful for the management of febrile infants under 60 days of age. What about an infant who is hypothermic? While prematurity, environmental exposure, or inadequate intake are associated with lower core body temperature, so are serious bacterial infections and viral infections, such as herpes simplex. What defines a hypothermic temperature in infancy and how should it be evaluated? Prior studies have found that infants with hypothermia have a serious bacterial infection up to 4% of the time.
In a study released this month in Pediatrics, Ramgopal et al. (10.1542/peds.2023-063000) surveyed clinicians working in emergency departments in 32 free-standing pediatric hospitals to assess how they define hypothermia and their approach to evaluating infants with hypothermia. Overall, they received 1,231 surveys (64% response rate).
The survey respondents had less confidence in caring for infants with hypothermia than those with fever (p<.01). Most defined a temperature of ≤36oC as hypothermia. Infants with hypothermia in the first 7 days of life were more apt to get a workup for serious bacterial and HSV infection than those who were 22–60 days old with hypothermia. The authors use these findings to make the case for prospective studies similar to what has been done for febrile infants. If you are looking to approach hypothermia with a desire that cooler heads prevail, then use this study as a means of giving you better insight into the problem. Stay cool and link to this study to learn more.
