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In perspective
Questions persist on the emergency department management of hypothermic young infants
  1. Sriram Ramgopal1,
  2. Paul L Aronson2,
  3. Mark I Neuman3,
  4. Christopher M Pruitt4
  5. for the Febrile Young Infant Research Collaborative
    1. 1 Pediatrics, Ann and Robert H Lurie Children's Hospital of Chicago, Chicago, Illinois, USA
    2. 2 Pediatrics and of Emergency Medicine, Yale School of Medicine, New Haven, Connecticut, USA
    3. 3 Emergency Medicine, Children's Hospital Boston, Boston, Massachusetts, USA
    4. 4 Pediatrics, Medical University of South Carolina, Charleston, South Carolina, USA
    1. Correspondence to Dr Sriram Ramgopal, Pediatrics, Ann and Robert H Lurie Children's Hospital of Chicago, Chicago, Illinois, USA; sramgopal{at}luriechildrens.org

    https://doi.org/10.1136/emermed-2021-211753

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      The management of the hypothermic young infant is a unique challenge for the emergency medicine provider. Most of these infants have a temperature abnormality related to relatively benign causes, such as low birth weight or prematurity. However, at least some infants who present with hypothermia are at risk of serious diagnoses, including invasive bacterial infections (IBI; defined as bacteraemia and/or bacterial meningitis). The aetiology of hypothermia in the setting of overwhelming sepsis remains unclear, with postulated reasons including an energy conservation mechanism or an altered immune response.1–3

      In contrast to research on febrile young infants,4 5 nearly all research on hypothermic IBI in infants has been limited to single-centre, retrospective studies.6–9 In the absence of clear data on the management of hypothermic young infants, there is broad variation in the care of the infants when presenting to the ED, as demonstrated in one study by Perry et al, which noted that only a quarter of 414 patients with a temperature <36.5°C underwent an evaluation for sepsis.9 Several studies suggest that infants with hypothermia have a lower incidence of serious bacterial infections (SBI, a broader term which also encompasses urinary tract infection (UTI) in addition to bacteraemia and/or meningitis) compared with the incidence of SBI among infants presenting with fever (approximately 9%10). Among the infants studied by Perry et al, seven (1.6%) had SBIs.9 A study by Ramgopal et al reported that 10/360 infants ≤60 days of age (2.8%) had SBIs, including 4 with IBI and 5 with UTI.6 A study reported by Wood et al of 68 neonates (≤28 days) with hypothermia identified that 2 (2.9%) had culture-positive SBI (both UTI).8 Finally, a study by Kasmire of 116 infants ≤60 days of age with hypothermia found SBIs in 3 (2.6%), …

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      Footnotes

      • Handling editor Gene Yong-Kwang Ong

      • Collaborators Febrile Young Infant Research Collaborative: Elizabeth R. Alpern, MD, MSCE (Ann and Robert H. Lurie Children’s Hospital of Chicago, Chicago, Illinois), Fran Balamuth, MD, PhD, MSCE (Children’s Hospital of Philadelphia, Philadelphia, Pennsylvania), Whitney L. Browning, MD (Vanderbilt University School of Medicine, Nashville, Tennessee), Adrienne G. DePorre, MD (Children’s Mercy Hospital, Kansas City, Missouri), Sanyukta Desai, MD, MSc (Cincinnati Children’s Hospital Medical Center, Cincinnati, Ohio), Elana A. Feldman, MD (Lucile Packard Children’s Hospital Stanford, Palo Alto, California), Rianna C. Leazer, MD (Children’s Hospital of The King’s Daughters, Norfolk, Virginia), Catherine E. Lumb, MD (University of Alabama at Birmingham, Birmingham, Alabama), Richard D. Marble, MD (Ann and Robert H. Lurie Children’s Hospital of Chicago, Chicago, Illinois), Russell J. McCulloh, MD (Children’s Mercy Hospital, Kansas City, Missouri), Christine E. Mitchell, BSN (Children’s Hospital of Philadelphia, Philadelphia, Pennsylvania), Lise E. Nigrovic, MD, MPH (Boston Children’s Hospital, Boston, Massachusetts), Sahar N. Rooholamini, MD, MPH (Seattle Children’s Hospital, Seattle, Washington), Laura F. Sartori, MD, MPH (Vanderbilt University School of Medicine, Nashville, Tennessee), Samir S. Shah, MD, MSCE (University of Cincinnati College of Medicine, Cincinnati, Ohio), Sarah J. Shin, BSN (Children’s Hospital of Philadelphia, Philadelphia, Pennsylvania), Marie E. Wang, MD, MPH (Stanford University School of Medicine, Palo Alto, California), Derek J. Williams, MD, MPH (Vanderbilt University School of Medicine, Nashville, Tennessee), Christopher Woll, MD (Yale School of Medicine, New Haven, Connecticut).

      • Contributors SR and CMP analysed and interpreted the work, and drafted it for intellectually important contents. PA and MN designed the work and revised the work for critically important content. All authors provided final approval of the version to be published and agreed to be accountable for all aspects of the work.

      • Funding This work is supported by CTSA grant number KL2 TR001862 (Aronson) from the National Center for Advancing Translational Sciences, a component of the National Institutes of Health and by the PEDSnet Scholars Training Programme (Ann and Robert H Lurie Children’s Hospital of Chicago) (Ramgopal).

      • Disclaimer The content is solely the responsibility of the authors and does not represent the official views of the National Institutes of Health.

      • Competing interests None declared.

      • Provenance and peer review Not commissioned; externally peer reviewed.