331 - Significant Pathology Diagnosed In Young Infants Presenting With Hypothermia

Poster Number: 331
Publication Number: 331.214

Julie K. Wood, Wake Forest School of Medicine of Wake Forest Baptist Medical Center, Winston Salem, NC, United States; Annalise Van Meurs, Doernbecher Children's Hospital at Oregon Health & Science University, Portland, OR, United States; Kathryn Westphal, Pediatrics, Columbus, OH, United States; Vignesh Doraiswamy, Ohio State University College of Medicine, Columbus, OH, United States; Meenu Sharma, Children's of Alabama, Birmingham, AL, United States; Stephanie Berger, University of Alabama School of Medicine, Birmingham, AL, United States; Saylor McCartor, University of South Carolina School of Medicine Greenville, Greenville, SC, United States; Meredith Mitchell, Children's Hospital of Richmond at VCU, Richmond, VA, United States; Clifton Lee, Virginia Commonwealth University School of Medicine, Richmond, VA, United States; John M. Morrison, Johns Hopkins All Children's Hospital, Saint Petersburg, FL, United States; Madhuri Prasad, Johns Hopkins All Children's Hospital, St. Petersburg, FL, United States; Monica Mattes, Children's Hospital Los Angeles, LOS ANGELES, CA, United States; Kira Molas-Torreblanca, Children's Hospital Los Angeles, Los Angeles, CA, United States; Sumeet L. Banker, Columbia University Vagelos College of Physicians and Surgeons, New York, NY, United States; Noah Hellermann, Columbia University Vagelos College of Physicians and Surgeons, New York, NY, United States; Coleton King, University of South Carolina School of Medicine Greenville, Clemson, SC, United States; Nicholas M. Potisek, University of South Carolina School of Medicine Greenville, Greenville, SC, United States; Elizabeth E. Halvorson, Wake Forest School of Medicine of Wake Forest Baptist Medical Center, Winston-Salem, NC, United States; On Behalf of the Hypothermic Young Infant Research Collaborative, University of South Carolina School of Medicine Greenville, Greenville, SC, United States

Background: Hypothermia in young infants is often attributed to immature thermoregulation but may be the presenting sign of significant pathology. Serious bacterial infections (SBI) and herpes simplex virus (HSV) have received substantial attention as eventual diagnoses; few studies have evaluated other outcomes in this cohort.

Objective: Determine the prevalence and type of significant pathology (defined as requiring hospitalization, treatment and/or monitoring) in young infants ≤ 90 days presenting with hypothermia. Evaluate patient demographics and clinical characteristics for associations with significant pathology.

Design/Methods: We conducted a multi-center, retrospective cohort study of young infants evaluated in the Emergency Department (ED) or hospital setting for reported or documented hypothermia (≤ 36.0 C) from September 1, 2016 to May 5, 2021. Patients were identified by billing codes and medical record query of patients with hypothermia within 24 hours of evaluation. Patients with hypothermia in the NICU or nursery, a central line, known trauma, fever, identified SBI or HSV, or inaccessible culture results were excluded. Patient charts were manually reviewed for data extraction. Discrete variables were tested using Chi-square test or Fisher’s exact test. We used a multiple logistic regression model to test clinical associations with significant pathology.

Results: Across 6 academic medical centers, 132/588 (22%) patients presenting with hypothermia were found to have significant pathology (Figure 1). Patient characteristics associated with a diagnosis of significant pathology included age, gestational age, ill appearance, repeated temperature instability, and medical complexity (Table 1). Following multiple logistic regression, both infant age of 7-28 days (OR 3.43, 95% CI 1.73-6.8) and > 28 days (OR 7.37, 95% CI 3.84–14.17) were associated with significant pathology. Additionally, ill appearance (OR 5.16, 95% CI 2.96–8.97), repeated temperature instability (OR 2.23, 95% CI 1.32-3.76) and medical complexity (OR 3.26, CI 95% 1.51-7.05) were associated with significant pathology while gestational age was not.Conclusion(s): We found 22% of young infants presenting with hypothermia have significant pathology. Infants >7 days of life, who are ill appearing, medically complex, or have repeated temperature instability are more likely to have significant pathology. Additional research is needed to further risk-stratify infants with hypothermia.
Figure 1. Significant Pathology (categories) in Young Infants with Hypothermia
Table 1. Demographics and Clinical Characteristics of Cohort (N = 588)