Clinical Characteristics, Etiology, and Outcomes of Hypothermia in Well-appearing Children Referred to the Emergency Department.

BACKGROUND

Hypothermia, as a sign of serious bacterial infection (SBI) in children and infants older than 90 days is poorly characterized, especially in the post-pneumococcal vaccine era.

OBJECTIVES

To assess the prevalence of SBI in children and infants presenting to the pediatric emergency department (PED) with reported or documented hypothermia.

METHODS

Retrospective data analysis was conducted of all well-appearing children aged 0-16 years who presented with a diagnosis of hypothermia at two tertiary PEDs from 2010 to 2019.

RESULTS

The study comprised 99 children, 15 (15.2%) age 0-3 months, 71 (71.7%) 3-36 months, and 13 (13.1%) > 36 months. The youngest age group had increased length of stay in the hospital (P < 0.001) and increased rates of pediatric intensive care unit admissions (P < 0.001). Empirical antibiotic coverage was initiated in 80% of the children in the 0-3 months group, 21.1% in the 3-36 months group, and 15.4% in > 36 months (P < 0.001). Only one case of SBI was recorded and no bacteremia or meningitis. Hypothermia of unknown origin was the most common diagnosis in all age groups (34%, 42%, 46%), respectively, followed by bronchiolitis (26%) and hypoglycemia (13.3%) for 0-3 month-old children, unspecified viral infection (20%) and otitis media (7%) for 3-36-month old, and unspecified viral infection (23%) and alcohol intoxication (15.2%) in > 36 months.

CONCLUSIONS

There is a low incidence of SBI in well-appearing children presenting to the PED with hypothermia and a benign course and outcome in those older than 3 months.