Bradycardia in Accidental Severe Hypothermia in a Newborn: Treat or Don’t Touch? A case report

Abstract

BackgroundHypothermia significantly affects mortality and morbidity of newborns. Literature about severe accidental hypothermia in neonates is limited. We present a case of a neonate suffering from severe accidental hypothermia. An understanding of the physiology of neonatal thermoregulation and hypothermia is important to decide on treatment.Case presentationWe report a case of severe accidental hypothermia (rectal temperature 25.7°C) in a hypothropic newborn due to prolonged exposure to low ambient temperature. The newborn presented bradycardic, bradypneic, lethargic, pale and cold. Bradycardia, bradypnea and consciousness were interpreted in the context of the measured body temperature. Therefore, no reanimation or intubation was initiated. The newborn was closely monitored and successfully treated only with active and passive rewarming. ConclusionClinical parameters such as heart frequency, blood pressure, respiration and consciousness must be interpreted in light of the measured body temperature. Medical treatment should be adapted to the clinical presentation. External rewarming can be a safe and effective measure in neonatal patients.

Profound Hypothermia Concomitant With Severe Coagulation Dysfunction and Leukopenia in a Preterm Infant

“…Complications of hypothermia may include severe metabolic disturbances, coagulopathy, thrombocytopenia, hypotension, pulmonary hypertension, hyperkalemia, hypocalcemia, anuria, intracranial, pulmonary or acute gastrointestinal bleeding, infections, and respiratory failure 11,12. Among these, coagulopathy is one of the most common complications of hypothermia in neonates 5,10. The most striking feature of the current case was the concomitant presence of severe coagulation dysfunction (aPTT >180 seconds and TT >240 seconds).…”

“…11,12 Among these, coagulopathy is one of the most common complications of hypothermia in neonates. 5,10 The most striking feature of the current case was the concomitant presence of severe coagulation dysfunction (aPTT >180 seconds and TT >240 seconds). There are several potential hypotheses for this mechanism.…”

“…The appropriate approach to rewarming hypothermic neonates remains controversial, with rapid versus slow rewarming the focus of considerable debate. Some scientists support rapid rewarming in infants with hypothermia and cardiac arrest when aggressive resuscitation and rewarming are generally recommended 10,29. In a study by Sofer and Benkovich,22 18 hypothermic infants presented to the emergency department with rectal temperature between 20°C and 28°C and underwent a rapid rewarming approach.…”

“…A cross-sectional study from Rwanda in Africa reported that of the 1021 eligible neonates, 205 neonates (73.2%) had mild hypothermia, 74 (26.4%) had moderate hypothermia, and only one (0.3%) had severe hypothermia 7. Although hypothermia is common in neonates, particularly preterm infants, profound hypothermia is very rare, even in preterm infants 9,10…”

“…7 Although hypothermia is common in neonates, particularly preterm infants, profound hypothermia is very rare, even in preterm infants. 9,10 Hypothermia increases the risk for neonatal mortality and morbidity in both full-term and preterm infants. 7 Neonatal hypothermia can also be prone to many complications, including metabolic disturbances, coagulopathy, and infection, 11 whereas therapeutic hypothermia that is evidence-based treatment of hypoxic ischemic encephalopathy (HIE) can also be prone to coagulopathy, as well as leukopenia.…”