Department of Pediatrics, Keck School of Medicine of USC, Children's Hospital Los Angeles, Los Angeles, California.
Department of Pediatrics, Children's Hospital of Richmond at Virginia Commonwealth University, Richmond, Virginia.
Hosp Pediatr. 2023 Aug 1;13(8):742-750. doi: 10.1542/hpeds.2023-007199.
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.
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.
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.
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.
有许多决策工具已被用于指导发热婴儿的管理，但对于表现为低体温的年轻婴儿的护理，仅有有限的数据可以指导。我们评估了参与医院和/或急诊部门的表现良好的低体温年轻婴儿之间的护理差异。
这是一项回顾性队列研究，纳入了 2016 年 9 月 1 日至 2021 年 5 月 5 日期间来自 9 所学术医疗中心的≤90 天的表现良好的婴儿。通过低体温或初始体温≤36.0°C 的计费代码和手动图表审查来识别婴儿。主要结局包括评估诊断评估、处置、经验性抗菌治疗和住院时间的差异。
在最初确定的 14278 名婴儿中，739 名符合纳入标准。所有主要结局均存在显著的医院间差异。在各个医院，对 12%至 76%的低体温婴儿进行了全面的严重细菌感染评估。经验性使用抗生素的比例为 20%至 87%。单纯疱疹病毒检测的比例为 7%至 84%，阿昔洛韦经验性使用的比例为 8%至 82%。住院率从 45%到 100%不等。
对于表现良好的低体温婴儿，在多个护理方面存在相当大的差异。更好地了解低体温婴儿及其感染风险可以导致开发临床决策工具来指导适当的评估和管理。
