314 - Prevalence of Invasive Bacterial Infection in Hypothermic Young Infants: A Multi-Center Study

Poster Number: 314
Publication Number: 314.213

Jennifer Raffaele, Prisma Health Upstate, University of South Carolina School of Medicine Greenville, Taylors, SC, 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; 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; Sumeet L. Banker, Columbia University Vagelos College of Physicians and Surgeons, New York, NY, United States; Sanford Williams, NewYork-Presbyterian Morgan Stanley Children's Hospital, New York, NY, United States; Coleton King, University of South Carolina School of Medicine Greenville, Clemson, SC, United States; Elizabeth E. Halvorson, Wake Forest School of Medicine of Wake Forest Baptist Medical Center, Winston-Salem, NC, United States; Nicholas M. Potisek, University of South Carolina School of Medicine Greenville, Greenville, SC, United States; On Behalf of the Hypothermic Young Infant Research Collaborative, University of South Carolina School of Medicine Greenville, Greenville, SC, United States

Background: Invasive bacterial illness (IBI) may present as hypothermia in young infants. Previous studies are limited by single-site design and small patient numbers. The largest study of hypothermic young infants relied on billing codes lacking access to clinical characteristics.

Objective: Determine prevalence of IBI (bacteremia and/or bacterial meningitis) in hypothermic young infants ≤ 90 days old. Secondary outcomes include prevalence of serious bacterial infection (SBI) (urinary tract infection, bacteremia, and/or bacterial meningitis) and neonatal herpes simplex virus (HSV). Evaluate patient demographics and clinical characteristics for associations with IBI.

Design/Methods: We conducted a 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 at 6 academic medical centers. 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, 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 IBI.

Results: We identified 632 patients, only 40% by billing codes. The majority were ≤ 28 days of life (71%) and well-appearing (79%). The majority (72%) of hypothermic young infants included had either a partial or full SBI evaluation performed, and 79% were admitted to the hospital. The prevalence of IBI was 2.4% (15/632) in hypothermic young infants; 15 patients had 17 blood and CSF cultures treated as pathogenic organisms. Prevalence of SBI was 4.6% (29/632) and neonatal HSV was 1.4% (9/632). Following multiple logistic regression for the primary outcome of IBI, only repeated temperature instability had a significant association (OR 6.72 95% CI 1.47-30.74) while age, gestational length, medical complexity, and ill appearance did not.Conclusion(s): Prevalence of IBI was 2.4% and SBI was 4.6%, similar to previous studies. Our study is the first multicenter study to include clinical characteristics of hypothermic young infants. We found repeated temperature instability to be associated with IBI. Better understanding the prevalence and clinical characteristics of IBI in hypothermic young infants can guide development of clinical decision tools to evaluate and manage this population.
Table 1: Demographics and Clinical Characteristics