Severe infantile hypothermia: Short- and long-term outcome

Objective: To determine short- and long-term outcomes of infants with severe hypothermia (≤ 28°C) treated in a pediatric intensive care unit (PICU). Design: (1) Retrospective evaluation of medical records of all patients admitted for severe infantile hypothermia from 1984 to 1993. (2) Medical and developmental evaluations of survivors of severe infantile hypothermia 3-12 years after hospital discharge. Setting: Six-bed PICU of a university teaching hospital. Patients: Eighteen infants who arrived at the emergency room with a rectal temperature between 20 and 28°C. Measurements and results: The ages of patients ranged between 5 and 30 days. Fifteen were Bedouins and three were Jews. Clinical features included sepsis in 9 (septic shock in 5 of 9) patients, respiratory failure in 11 and overt bleeding in 5. Rewarming was applied using rapid external warming under a radiant heater. Five infants died shortly after arrival and one patient at age 6 years; all of them had sepsis on arrival. Of the 12 survivors examined at ages 3-12 years, ten had normal psychomotor achievements, while the remaining two had mild (1 patient) and severe (1 patient) psychomotor retardation. Both of the latter two had sepsis on first admission for hypothermia. All nine hypothermic infants, who had no sepsis, had normal medical examinations and normal developmental achievements for their ages. Conclusion: Severe infantile hypothermia is a serious condition. When treating patients in a modern PICU, morbidity and mortality are mainly related to the presence or absence of an associated septicemia. Infants without septicemia may have normal growth and development.