Hypothermia in Pediatric Practice

Hypothermia is defined as a core temperature of 35 C ( 95 F ) or less. It occurs when the body is no longer able to sustain normal body temperature. Onset of hypothermia depends on the imbalance between increased heat loss and decreased heat production.

Immediate Assessment and Questions

• What are the vital signs? Is there a Pulse?
• Is the patient breathing?
• What is the clinical setting? Very young children are susceptible to hypothermia as a result of environmental exposure.
• Any history of other medical problems like hypoglycemia, hypopituitarisim and hypoadrenalisim may present with hypothermia.
• Any possible source of infection. Septic patients may present with hypothermia.

Physical Examination

• Vital signs
• Measure core body temperature , pulse and B.P
• Volume status
• Volume status should be continuously monitored. Observe for signs of trauma or any continuing blood loss.

Neurological exam
Check mental status and perform a complete neurological exam if the patient is not comatose.

Workup

• CBC: To help rule out conditions such as sepsis and to determine Hb concentration and oxygen carrying capacity.
• Basic Metabolic panel: Provides clues to volume status, hypoglycemia and electrolyte disturbance.
• Urinalysis
• ABGs : Provides acid-base status a nd oxygenation status.
• Chest X-ray: To look for pulmonary edema or aspiration

Physiology of Hypothermia in childrenChildren have a higher surface area to mass ratio than adults and therefore cool faster and become hypothermic at an increased rate. Environmental factors like cold, wind and inadequate clothing can increase heat loss. Heat production can be affected by such factors as age, trauma and medical illness.

Stages of Hypothermia

1. Mild – Core temperature 32 to 35ºC (90 to 95ºF)
2. Moderate – Core temperature 28 to 32ºC (82 to 90ºF)
3. Severe – Core temperature below 28ºC (82ºF)

Management

• Treatment must address the underlying condition that has impaired thermoregulation.
• Restore Warmth Slowly
• Get the patient indoors
• Remove wet clothing and dry the patient off, if needed.
• Warm the patient’s trunk first, not hands and feet. Warming extremities first can cause shock.
• Warm the patient by wrapping him or her in blankets or putting dry clothing on the person.
• Do not immerse the patient in warm water. Rapid warming can cause heart arrhythmia.
• If using hot water bottles or chemical hot packs, wrap them in cloth; don’t apply them directly to the skin.

Begin CPR, if Necessary, While Warming Person

If the child is not breathing normally:
Start CPR for children.
Continue CPR until the patient begins breathing or emergency help arrives.

Give Warm Fluids
Give the patient a warm drink, if conscious. Avoid caffeine or alcohol.

Keep Body Temperature Up
Once the body temperature begins to rise, keep the patient dry and wrapped in a warm blanket. Wrap the child’s head and neck as well.