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Temperature threshold in the screening of bacterial infections in young infants with hypothermia
  1. Yu Hsiang Johnny Lo1,
  2. Christopher Graves2,
  3. Jamie Lynn Holland3,
  4. Alexander Joseph Rogers4,
  5. Nathan Money5,
  6. Andrew Nobuhide Hashikawa4,
  7. Sriram Ramgopal6
  1. 1Emergency Medicine, NewYork-Presbyterian Hospital/Weill Cornell Medicine, New York, New York, USA
  2. 2Emergency Medicine, Pediatric Emergency Medicine Associates (PEMA), Atlanta, Georgia, USA
  3. 3Pediatrics, Medical College of Wisconsin, Milwaukee, Wisconsin, USA
  4. 4Emergency Medicine and Pediatrics, University of Michigan, Michigan Medicine, Ann Arbor, Michigan, USA
  5. 5Pediatrics, University of Utah School of Medicine, Salt Lake City, Utah, USA
  6. 6Emergency Medicine, Ann and Robert H Lurie Children's Hospital of Chicago, Chicago, Illinois, USA
  1. Correspondence to Dr Yu Hsiang Johnny Lo, Emergency Medicine, NewYork-Presbyterian Hospital/Weill Cornell Medicine, New York, New York 10065, USA; vke9004{at}med.cornell.edu

Abstract

Background Young infants with hypothermia presenting to the emergency department (ED) are at risk for serious bacterial infections (SBI), however there is no consensus temperature to prompt evaluation for SBI among these children. We sought to statistically derive a temperature threshold to guide detection of SBI in young infants with hypothermia presenting to the ED.

Methods We performed a cross-sectional study of infants ≤90 days old presenting to four academic paediatric EDs in the United States of America from January 2015 through December 2019 with a rectal temperature of ≤36.4°C. Our primary outcomes were SBI, defined as urinary tract infection (UTI), bacteraemia and/or bacterial meningitis, and invasive bacterial infections (IBI, limited to bacteraemia and/or bacterial meningitis). We constructed receiver operating characteristic (ROC) curves to evaluate an optimally derived cutpoint for minimum ED temperature and presence of SBI or IBI.

Results We included 3376 infants, of whom SBI were found in 62 (1.8%) and IBI in 16 (0.5%). The most common infection identified was Escherichia coli UTI. Overall, cohort minimum median temperature was 36.2°C (IQR 36.0°C–36.4°C). Patients with SBI and IBI had lower median temperatures, 35.8°C (IQR 35.8°C–36.3°C) and 35.4°C (IQR 35.7°C–36.3°C), respectively, compared with those without corresponding infections (both p<0.05). Using an outcome of SBI, the area under the ROC curve (AUROC) was 61.0% (95% CI 54.1% to 67.9%). At a cutpoint of 36.2°C, sensitivity was 59.7% and specificity was 59.2%. When using an outcome of IBI, the AUROC was 65.9% (95% CI 51.1% to 80.6%). Using a cutpoint of 36.1°C in this model resulted in a sensitivity of 68.8% and specificity of 60.1%.

Conclusion Young infants with SBI and IBI presented with lower temperatures than infants without infections. However, there was no temperature threshold to reliably identify SBI or IBI. Further research incorporating clinical and laboratory parameters, in addition to temperature, may help to improve risk stratification for these vulnerable patients.

  • infections
  • hypothermia
  • pediatric emergency medicine

Data availability statement

No data are available.

Data availability statement

Data are available on reasonable request.

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Data availability statement

No data are available.

Data availability statement

Data are available on reasonable request.

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Footnotes

  • Handling editor Gene Yong-Kwang Ong

  • Contributors YHJ refined data collection elements, supervised site data collection, interpreted the data, drafted the initial manuscript and critically reviewed and revised the manuscript. SR conceptualised and refined the study, collected and reviewed site data, conducted formal data analyses, critically reviewed and revised the manuscript. AJR and ANH refined the study design, critically reviewed and revised the manuscript. CG, NM and JLH supervised site data collection, refined the study design, critically reviewed and revised the manuscript. YHJ is the guarantor for the study. All authors approved the final manuscript as submitted and agreed to be accountable for all aspects of the work.

  • Funding SR is sponsored by PEDSnet (Department of Pediatrics, Ann and Robert H Lurie Children’s Hospital). REDCap is supported at Feinberg School of Medicine by the Northwestern University Clinical and Translational Science (NUCATS) Institute. Research reported in this publication was supported, in part, by the National Institutes of Health's National Center for Advancing Translational Sciences, Grant Number UL1TR001422. All authors have no financial relationships relevant to this article to disclose.

  • Competing interests None declared.

  • Patient and public involvement Patients and/or the public were not involved in the design, or conduct, or reporting, or dissemination plans of this research.

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