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Note: controversies are not meant to have a “right” answer – they are to see how most people are practicing. Would love your comments also regarding your thought processes and the evidence behind your decisions. We can learn from each other!
A 17mo old is brought in for rhinorrhea and mild cough. The patient is well-appearing, has no past medical history, is not on any medications, and is up to date on immunizations. Physical examination is normal. Vital signs are: temperature 35.8 rectal, heart rate 100, respiratory rate 24, blood pressure 85/42, pulse ox 100% on room air. The child is wearing a standard hospital gown and was brought in wearing appropriate clothing for the ambient mild outdoor weather. What would you do given the hypothermic rectal temperature?
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November 19, 2020 at 12:26 am
A core temperature < 36.0 is considered hypothermic. Axillary, oral, and tympanic temperatures are less reliable for assessing hypothermia, and the diagnosis should be based on a rectal temperature. The literature supports hypothermia as a clear harbinger of potential serious illness in neonates and young infants. The risk of serious bacterial illness (SBI) was assessed in a small study of neonates < 28 days old (PMID 29970399) and of a large study of infants < 90 days old with hypothermia (PMID 32446472) (defined as < 36.1 in the first study and admission or discharge ICD code for hypothermia in the second). Both studies found ~8% had SBI. Hypothermia is also a risk factor for increased mortality in patients known to be septic. However, it is unclear if hypothermia alone is a risk factor for SBI in a well-appearing otherwise normal and healthy child outside the neonate to early infant age.