PM2036: Variation in Care for Hypothermic Young Infants Across Academic Medical Centers

Background: The prevalence of serious bacterial infections (SBI) in hypothermic infants ≤90 days old is as high as 8%. Evidence-based guidelines on the standard of care for hypothermic young infants is lacking, and thus we hypothesize there is significant variation in the evaluation and management of this population. Our objective is to assess the variation in care for infants ≤90 days of age who have reported or documented hypothermia (≤36.0C) at initial presentation to a healthcare facility across sites.

Methods: A retrospective, cross-sectional multicenter study of hypothermic infants ≤90 days of age evaluated in six emergency departments or hospitals, from September 2016 to May 2021, was conducted. Eligible patients were identified by billing codes corresponding to hypothermia and by medical record query for infants ≤90 days old with a temperature of ≤36C on initial presentation or reported at home. We assessed variation in septic work-up, herpes simplex virus (HSV) testing, and empiric antibiotic administration. Analyses were conducted using ANOVA and Kruskal-Wallis tests, with a p-value ≤0.05 considered statistically significant. Further analyses of the data to assess variation of outcomes based on demographic characteristics such as gestational age, age of presentation, and degree of hypothermia is ongoing.

Results: We included 629 infants (295 female). Most (48%) presented in the first week of life and did not have a complex medical condition (90%). More than half (51%) were born full term, while 28% were late-preterm, and 8% less than 34 weeks. Only 22% were noted be ill-appearing on presentation (Table 1). Overall, 46% underwent a full septic work-up (blood, urine and cerebrospinal fluid (CSF) cultures), while 25% underwent partial work up (at least one, but < 3 cultures), and 28% had no cultures collected. The majority (72%) did not receive HSV testing. About half (57%) received empiric antibiotics. There were significant differences in percentage of patients that underwent a sepsis work-up, HSV testing, and empiric antibiotic administration (Table 2).

Conclusion: For febrile young infants, there are many evidence-based guidelines that stratify patients by risk and outline the standard of care for management. Without the same for hypothermic young infants, this study shows the significant variation that exists in testing and treatment. With ongoing analyses, we aim to stratify hypothermic infants at greatest risk of SBI in order to inform creation of future practice guidelines for their management.