Abstract
Background
We sought to investigate risk factors for serious bacterial infection (SBI: bacterial
meningitis, bacteremia, and urinary tract infection [UTI]) among infants ≤60 days
of age presenting to the emergency department (ED) with hypothermia (temperature < 36 °C).
Methods
We performed a single center study over a 12-year period including all patients ≤60 days
old with hypothermia, excluding patients who did not receive a blood culture and patients
who received antibiotics prior to culture acquisition. The primary outcome was SBI.
Secondary outcomes were mortality and herpes simplex infection. We performed multivariable
logistic regression to identify risk factors for primary outcomes reporting adjusted
odds ratios with 95% confidence intervals (aOR, 95% CI).
Results
360 infants were identified. 10/360 (2.8%) had an SBI. All episodes of SBI occurred
in infants ≤28 days of age. Two patients had meningitis, two had meningitis with bacteremia,
one had isolated bacteremia, and five had UTI. Associated diagnoses included prematurity
(46.9%), hyperbilirubinemia (28.3%) and dehydration (14.7%). In multivariable analysis,
presentation at 15–28 days (7.60, 1.81–31.86; p = 0.005) compared to 0–14 days, higher absolute neutrophil count (1.25, 1.04–1.50;
p = 0.015) and lower platelet count (0.99, 0.99–1.00; p = 0.046) were associated with SBI. Three patients without SBI died during or soon
after their hospitalization. One patient had positive testing for herpes simplex.
Conclusion
In this cohort of hypothermic infants, 2.8% had a SBI. Age of presentation, ANC, and
lower platelet count were associated with serious infections. Hypothermic infants
presenting to the ED carry significant morbidity and require prospective study to
better risk-stratify this population.
Keywords
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Article Info
Publication History
Published online: April 11, 2019
Accepted:
April 10,
2019
Received in revised form:
April 9,
2019
Received:
April 4,
2019
Identification
Copyright
© 2019 Elsevier Inc. All rights reserved.
