Clinical Characteristics, Etiology and Outcomes of Hypothermia in Well Appearing Children Referred to Emergency Department
2Department of Pediatric Emergency Medicine, Hadassah-Hebrew University Medical Center, Jerusalem
3Department of Pediatric Emergency Medicine, Shaare Zedek Medical Center, Jerusalem
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.
Methods: Retrospective data analysis of all well-appearing children aged 0-16 years who presented with a diagnosis of hypothermia to two tertiary pediatric emergency departments (PEDs) in Jerusalem, Israel, from 2010 to 2019.
Results: Ninety-nine children were included in this study. Of these, 15 (15.2%) were aged 0–3 months, 71 (71.7%) 3–36-months and 13 (13.1%) were older than 36 months. The 0–3-months age group had increased Length of Stay (LOS) in the hospital (p<0.001) and increased rates of Pediatric Intensive Care Unit (PICU) admissions (p<0.001) compared to the other groups. 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 those older than 36 months (p < 0.001); however, only one case of SBI was recorded and no case of bacteremia or meningitis.
Hypothermia of unknown origin was the most common diagnosis in all age groups (34%,42%,46%) followed by bronchiolitis (26%) and hypoglycemia (13.3%) in the 0–3-month-old group, unspecified viral infection (20%) and otitis media (7%) in the 3–36-month-old group and unspecified viral infection (23%) and alcohol intoxication (15.2%) in those older than 36 months.
Conclusion: 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.