Category: Pediatrics
Keywords: Infant, hypothermia, sepsis screen (PubMed Search)
Posted: 5/16/2025 by Jenny Guyther, MD
(Updated: 6/22/2025)
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While there are numerous evidence-based recommendations for the management of febrile infants, there are not clear guidelines for the management of hypothermic infants (0-90 days).
A recent review article offered the following summary points from the literature:
The World Health Organization defines hypothermia as a temperature < 36.4 degrees Celsius while the International Pediatric Sepsis Consensus Conference uses < 36.0 degrees Celsius. A multicenter study attempted to empirically derive a threshold for hypothermia but was not successful.
One study looking at the age of presentation of hypothermic patients showed that > 50% of the infants that presented were < 7 days old.
There are numerous reasons that an infant can be hypothermic, including bacterial infections such as urinary tract infections, bacteremia or meningitis, viral infections (herpes simplex virus) or environmental factors. Premature infants can also have temperature instability as can those with insufficient caloric intake.
Serious bacterial infection (defined as urinary tract infections, bacteremia or meningitis ) occurred less frequently in hypothermic infants compared to febrile infants, but the rates of invasive bacterial infections (defined as bacteremia and meningitis) were the same between the two groups.
In 112 patients with neonatal HSV, 5.2% of the cases were hypothermic, 30.9% had fever and 63.9% had no change in temperature.
Important questions/exam findings to raise suspicion for a pathological cause of hypothermia:
Perinatal history: Gestational age, GBS and HSV status of mom, perinatal antibiotics, and potential exposures to HSV.
Weight change, activity change, interest in feeding, abnormal movements, changes in breathing pattern, ill appearance
Some institutions will group the evaluation of hypothermic infants into the febrile infant guidelines, but there are currently no evidence-based pathway's. Striking a balance between over testing and not missing a serious bacterial infection is difficult and an area that requires additional research.
Ramgopal S, Lo YHJ, Potisek NM, Money NM, Halvorson EE, Cruz AT, Rogers AJ. Current Evidence on the Care of Young Infants With Hypothermia in the Emergency Department. Pediatr Emerg Care. 2025 Feb 1;41(2):146-151. doi: 10.1097/PEC.0000000000003259. PMID: 39883795.
