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. 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.