312 - Implementation of a Hypothermic Young Infant Pathway a Single Site Study

Poster Number: 312
Publication Number: 312.213

Saylor McCartor, University of South Carolina School of Medicine Greenville, Greenville, SC, United States; Jennifer Raffaele, Prisma Health Upstate, University of South Carolina School of Medicine Greenville, Taylors, SC, United States; Xiyan Tan, Clemson University, Clemson, SC, United States; Grace C. Williams, Decatur Morgan Hospital, Hartselle, AL, United States; Mark Krom, Prisma Health Children's Hospital - Upstate, Greenville, SC, United States; Elizabeth Tyson, Prisma Health-Upstate, Greenville, SC, United States; Kevin A. Polley, Prisma Health Upstate, Greenville, SC, United States; Jimme Sierakowski, Prisma Health Upstate, Greenville, SC, United States; Nicholas M. Potisek, University of South Carolina School of Medicine Greenville, Greenville, SC, United States

Background: Hypothermia can be a presenting symptom for young infants with serious bacterial infection (SBI). Unlike febrile infants, no clinical guidelines exist to guide evaluation of hypothermic young infants. Our institution developed an evidence-based hypothermic young infant pathway.

Objective: Assess diagnostic evaluation, empiric therapies, and patient disposition before and after implementation of a hypothermic young infant (≤ 60 days old) pathway.

Design/Methods: We conducted a single-site retrospective chart review in young infants evaluated in our Emergency Department (ED) or hospital for hypothermia from September 1, 2016 to May 5, 2021. The pathway was implemented May 5, 2020. Patients were identified by billing codes and medical record query of patients with hypothermia within 24 hours of evaluation. Exclusion criteria included infants with hypothermia in the NICU or nursery, central lines, known trauma, and fever. Patient charts were manually reviewed for data extraction. Outcomes compared before and after pathway implementation included full or partial SBI evaluations, herpes simplex virus (HSV), empiric antibiotics, hospital admission, length of stay (LOS), and readmission. Continuous variables were tested using t test or Wilcoxon sign rank test, while discrete variables were analyzed using Chi-square or Fisher test.

Results: We identified 190 patients, 157 in the pre-intervention group and 33 in the post-intervention group. Both groups were similar in age and ill appearance with additional demographics in Table 1. In the pre-intervention group 2.5% of patients had SBI, while 5.7% had SBI in the post-intervention group. 2 cases of HSV were detected in the pre-intervention group compared to none in the post-intervention group. Study outcomes are demonstrated in Table 2. We saw no statistically significant difference in no SBI evaluation (3.82% vs 12.12%), HSV testing (75.8% vs 75.8%) and empiric antibiotic use (68.8% vs 54.6%). In the post-intervention group, more infants were discharged from the ED (2.6% vs 18.2%; p < 0.005). LOS was not statistically different between intervention groups (129.4 +/- 211.3 hrs vs 208.68 +/- 280.l hrs). No difference in readmission rates occurred.Conclusion(s): Following implementation of a hypothermic young infant pathway, a larger percentage of infants were discharged from the ED. Data collection is ongoing to adequately power investigations of diagnostic work-up and empiric antibiotic use.
Curriculum VitaeCurriculum Vitae- Saylor McCartor.pdf
Table 2: Other Primary Outcomes (pre vs post)