Presented at the Neonatal Society 2007 Spring Meeting.

Swamy R, Cleaver C, Gristwood G, Lal M

Neonatal unit, The James Cook University Hospital, Middlesbrough TS4 3BW, UK

Introduction: Hyperthermia is thought to be associated with poor neurological outcomes in babies and there may be benefit from cooling (1,2). In the past, clinicians and nurses caring for newborns have given more emphasis on the management of hypothermia than hyperthermia. In light of the emerging evidence on hyperthermia, we wanted to find out the nature and extent of this problem during transport of sick infants in our population.

Aim: To look at the incidence and short-term outcome of infants who had hyperthermia during transport.

Methods: This was an observational study done at The James Cook university hospital. Data was collected prospectively on all transfers between Jan 2002 to Dec 2006 (5 years). Babies with temperature ≥38ºC were identified from the transfer records and data were collected on gestation, weight, underlying diagnosis and management of hyperthermia. Short-term outcome was assessed at the time of discharge from the hospital. This clinical audit did not require ethical approval.

Results: During the study period, there were 685 transfers and 25 (3.6%) babies were noted to have hyperthermia. The median gestation and birth weight were 37 weeks (range 31- 42) and 2900 gm (range 1120-5400 gm) respectively. The underlying diagnoses were sepsis in 12(48%) infants, encephalopathy in 5 (20%) and surgical/cardiac in the remaining 8 (32%) infants. Ten infants developed hyperthermia during transport while 15 infants were noted to have high temperature before transfer. Incubator temperature was reduced in 23 cases but was successful in reducing body temperature in only 8 (34%) infants. Paracetamol was effective in one case and hyperthermia settled in the last case with no intervention. Five (20%) babies had abnormal neurology which was predominantly in the form of seizures and hypertonia but there were no deaths in this group.

Conclusion: Hyperthermia during transport of sick infants appears to be a problem in our population. Reducing the incubator temperature alone has not been effective within this group. Other interventions such as medications would appear to be essential to manage hyperthermia during transport. It is difficult to relate any causal link between abnormal neurology and hyperthermia in this audit.

References
1. Gluckman PD, Wyatt JS, Azzopardi D, et al. Selective head cooling with mild systemic hypothermia after neonatal encephalopathy: multicentred randomised tr ial. Lancet 2005; 365:667–70.
2. Eicher DJ, Wagner CL, Katikaneni LP, et al. Moderate hypothermia in neonatal encephalopathy: efficacy outcomes. Pediatr Neurol 2005;32:11–17