TY - JOUR
T1 - Variation in Care of Well-Appearing Hypothermic Young Infants
T2 - A Multisite Study
AU - Combs, Monica D.
AU - Mitchell, Meredith
AU - Molas-Torreblanca, Kira
AU - Lee, Clifton
AU - Raffaele, Jennifer L.
AU - Sharma, Meenu
AU - Berger, Stephanie
AU - Morrison, John
AU - Prasad, Madhuri
AU - Wood, Julie K.
AU - Van Meurs, Annalise
AU - Mullin, Rachael
AU - Doraiswamy, Vignesh
AU - Ingram, Evan
AU - Banker, Sumeet L.
AU - Lee, Jennifer
AU - Tan, Xiyan
AU - Potisek, Nicholas M.
AU - Halvorson, Elizabeth E.
N1 - Publisher Copyright:
© 2023 by the American Academy of Pediatrics.
PY - 2023
Y1 - 2023
N2 - BACKGROUND AND OBJECTIVES: Numerous decision tools have emerged to guide management of febrile infants, but limited data exist to guide the care of young infants presenting with hypothermia. We evaluated the variation in care for well-appearing hypothermic young infants in the hospital and/or emergency department setting between participating sites. METHODS: This is a retrospective cohort study of well-appearing infants ≤90 days old across 9 academic medical centers from September 1, 2016 to May 5, 2021. Infants were identified via billing codes for hypothermia or an initial temperature ≤36.0°C with manual chart review performed. Primary outcomes included assessment of variation in diagnostic evaluation, disposition, empirical antimicrobial therapy, and length of stay. RESULTS: Of 14 278 infants originally identified, 739 met inclusion criteria. Significant interhospital variation occurred across all primary outcomes. Across sites, a full serious bacterial illness evaluation was done in 12% to 76% of hypothermic infants. Empirical antibiotics were administered 20% to 87% of the time. Performance of herpes simplex viral testing ranged from 7% to 84%, and acyclovir was empirically started 8% to 82% of the time. Hospital admission rates ranged from 45% to 100% of patients. CONCLUSIONS: Considerable variation across multiple aspects of care exists for well-appearing young infants presenting with hypothermia. An improved understanding of hypothermic young infants and their risk of infection can lead to the development of clinical decision tools to guide appropriate evaluation and management.
AB - BACKGROUND AND OBJECTIVES: Numerous decision tools have emerged to guide management of febrile infants, but limited data exist to guide the care of young infants presenting with hypothermia. We evaluated the variation in care for well-appearing hypothermic young infants in the hospital and/or emergency department setting between participating sites. METHODS: This is a retrospective cohort study of well-appearing infants ≤90 days old across 9 academic medical centers from September 1, 2016 to May 5, 2021. Infants were identified via billing codes for hypothermia or an initial temperature ≤36.0°C with manual chart review performed. Primary outcomes included assessment of variation in diagnostic evaluation, disposition, empirical antimicrobial therapy, and length of stay. RESULTS: Of 14 278 infants originally identified, 739 met inclusion criteria. Significant interhospital variation occurred across all primary outcomes. Across sites, a full serious bacterial illness evaluation was done in 12% to 76% of hypothermic infants. Empirical antibiotics were administered 20% to 87% of the time. Performance of herpes simplex viral testing ranged from 7% to 84%, and acyclovir was empirically started 8% to 82% of the time. Hospital admission rates ranged from 45% to 100% of patients. CONCLUSIONS: Considerable variation across multiple aspects of care exists for well-appearing young infants presenting with hypothermia. An improved understanding of hypothermic young infants and their risk of infection can lead to the development of clinical decision tools to guide appropriate evaluation and management.
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U2 - 10.1542/hpeds.2023-007199
DO - 10.1542/hpeds.2023-007199
M3 - Article
C2 - 37503559
AN - SCOPUS:85168538612
SN - 2154-1663
VL - 13
SP - 742
EP - 749
JO - Hospital pediatrics
JF - Hospital pediatrics
IS - 8
ER -