What is the appropriate workup for a child with hypothermia?

From the Guidelines

Initial Assessment and Management

For a hypothermic child, immediate assessment and management are crucial, as emphasized by the 2024 American Heart Association and American Red Cross guidelines for first aid 1. The initial workup should include measuring the child's core temperature, ideally using a rectal or esophageal probe. If the child's temperature is below 32°C (89.6°F), they should be treated for severe hypothermia.

Rewarming Strategies

The child should be gently removed from any wet clothing and placed in a warm environment.

• Passive rewarming with blankets or a warm bed is recommended for mild hypothermia (32-35°C or 89.6-95°F) 1.
• For moderate to severe hypothermia (below 32°C or 89.6°F), active rewarming methods such as warm IV fluids, heated humidified oxygen, and/or a warming blanket may be used.

Laboratory Tests and Medications

Laboratory tests should include:

• A complete blood count
• Blood glucose
• Electrolyte panel
• Arterial blood gas to assess for any underlying conditions or complications An electrocardiogram (ECG) should also be performed to evaluate for any cardiac arrhythmias. Medications such as:
• Naloxone (0.1 mg/kg IV) may be considered if there is suspicion of opioid overdose
• Broad-spectrum antibiotics (e.g., ceftriaxone 50 mg/kg IV) may be started if there is concern for sepsis
• Vasopressors such as dopamine (5-20 mcg/kg/min IV) or norepinephrine (0.1-1 mcg/kg/min IV) may be used to support blood pressure if necessary.

Monitoring and Reevaluation

Close monitoring of the child's vital signs, including temperature, heart rate, blood pressure, and oxygen saturation, is essential during the rewarming process 1. The child should be reevaluated frequently to assess for any improvement or deterioration in their condition.

From the Research

Diagnosis and Management of Hypothermia in Children

The diagnosis and management of hypothermia in children involve several key considerations, including:

• The definition of hypothermia as a core body temperature below 35ºC (95ºF) 2
• The risk factors for hypothermia, including age, environmental exposure, and underlying medical conditions
• The importance of quick rewarming and appropriate disposition to improve outcomes 2

Diagnostic Workup for Hypothermic Infants

The diagnostic workup for hypothermic infants may include:

• Testing for serious bacterial infections (SBI) and herpes simplex virus (HSV) infections, as these are potential complications of hypothermia 3, 4
• Blood, urine, and cerebrospinal fluid (CSF) cultures, as well as inflammatory markers such as C-reactive protein (CRP) and procalcitonin 3, 4
• Consideration of the infant's age, temperature, and clinical presentation when determining the need for testing and treatment 3, 4

Treatment and Rewarming Strategies

Treatment for hypothermia in children may involve:

• Passive or active rewarming measures, depending on the severity of the hypothermia 2
• Slow rewarming, which is advocated for in some cases, although the optimal rewarming rate is not well defined 5
• Consideration of the potential risks and benefits of rapid rewarming, which remains a topic of controversy 5

Variability in Care and the Need for Standardization

There is significant variability in the care of hypothermic infants, including:

• Differences in diagnostic testing, antimicrobial treatment, and disposition between hospitals and over time 4
• A need for evidence-based guidelines to standardize care and improve outcomes for hypothermic infants 3, 4