65 - Hypothermia in young infants: a sign of more than just infection

Poster Number: 65
Publication Number: 65.105

Christopher E. Graves, WakeMed Children's Hospital WakeMed Health and Hospitals, Raleigh, NC, United States; Alexander J. Rogers, University of Michigan Medical School, Ann Arbor, MI, United States; Yu Hsiang J. Lo, University of Michigan, Ann Arbor, MI, United States; Jamie Holland, University of Utah School of Medicine, Salt Lake City, UT, United States; Nathan Money, University of Utah School of Medicine, Salt Lake City, UT, United States; Andrew N. Hashikawa, University of Michigan Medical School, Dexter, MI, United States; Sriram Ramgopal, Ann & Robert H. Lurie Children's Hospital of Chicago, Chicago, IL, United States

Background: While the association between hypothermia in young infants and serious bacterial infection (SBI) is well described, infants with hypothermia in the emergency department (ED) may be at risk of other serious conditions.

Objective: To characterize significant diagnoses among young infants presenting to the ED with hypothermia.

Design/Methods: We performed a retrospective study at four pediatric EDs from January 2015 to December 2019, including patients ≤90 days old with an International Classification of Disease 9th or 10th revision diagnosis code of hypothermia, chief complaint of hypothermia, or minimum rectal temperature of ≤36.5°C. We excluded any patients discharged from the ED and those diagnosed with SBI (urinary tract infection, bacteremia and/or meningitis). Our primary outcome was diagnosis, categorized using two grouping systems: the Diagnosis Grouping System (DGS) and the pediatric complex chronic conditions (CCC). Our secondary outcome was in-hospital mortality.

Results: 1,484 patients were included (54% male, median age 17 days [IQR 5-42]). A CCC was present in 355 (23.9%), with a greater proportion among patients 61-90 days old (n=65, 32.7%) and patients with a minimum temperature of ≤35.5°C (n=74, 37.6%; p < 0.01 for both; Figure). The most common CCCs were in the neonatal/premature (29.4%) and cardiovascular (26.5%) categories (Figure). The most common DGS major groups identified were “other”, gastrointestinal diseases, and respiratory diseases (Table 1). On closer inspection, the most common primary diagnoses based on ICD codes were jaundice (189, 12.7%), disturbance of temperature regulation or hypothermia (182, 12.3%), bronchiolitis (97, 6.5%), and problems of nutrition and feeding (96, 6.5%). There were 55 (3.7%) patients with pyloric stenosis, 14 (0.9%) with congenital heart defects, and 15 (1.0%) with traumatic brain injury. There were 15 (1.0%) infants with in-hospital mortality, with diagnoses that included traumatic brain injury, cardiac arrest, respiratory failure, and metabolic disorders (Table 2).Conclusion(s): Among young infants admitted from the ED with hypothermia, a high proportion (23.9%) had a CCC. Significant clinical diagnoses identified included jaundice, bronchiolitis, congenital anatomic defects, and traumatic injuries. A significant proportion (1.0%) sustained in-hospital mortality. Future research targeted towards the development of a clinical practice guideline for the management of this vulnerable population may benefit from the inclusion of serious diagnoses unrelated to SBI.
PAS CV (Final).pdf
Table 1. Diagnosis Grouping System (DGS) classification of hypothermic patients stratified by age