ICE Study: Illness vs Cold Exposure in Neonates, a Retrospective Review

Background: Neonatal hypothermia has always had associated concerns for infectious processes. To date, there have been no studies that have looked at infection rates of those seen for neonatal hypothermia in the Emergency Department (ED).

Methods: This is a single-center retrospective review of patients seen from 1/1/2015 to 12/01/2020 with a presenting complaint of hypothermia in our emergency department. Subjects were included if they were under 30 days of life and had hypothermia as a presenting complaint or found in the ED, which was defined as a core body temperature less than 36 degrees Celsius. Charts of these patients were reviewed for demographic data, evaluation, disposition, culture results, and outcomes.

Results: A total of 144 subjects were seen in the Pediatric Emergency Department at our tertiary care center during the five-year study period. Upon review, blood and urine cultures were obtained on 138 of these patients and CSF studies were performed on 130 subjects. There were 6 subjects observed and discharged home. None of these returned within one month based on electronic medical record review. Of the 130 CSF cultures, none were positive (95% confidence interval 0-2.3%). One of the 138 blood cultures was positive, a presumed contaminant (true positivity rate 95% CI 0-2.2%). None of the 138 urine cultures were positive. Of the 138 subjects admitted, 17 patients had bradypnea or apnea in the ED. There were four subjects who required endotracheal intubation. All 17 subjects were supported and safely discharged home. Two subjects (out of 132) had surface cultures positive for HSV without any associated serum or CSF HSV findings (95% CI 0-3.6%). Those subjects were normothermic in the ED and had unremarkable hospital courses.

Conclusion: These findings from our single-center retrospective review suggest neonates presenting with hypothermia is rarely related to infection. A multi-center review is needed to more definitively outline the risk of hypothermia in this population.