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Isn’t a normal rectal temp <38 and not 37 which is a “normal” oral temp?

don
On Feb 26, 2014, at 12:08 PM, Peter Auerbach <[log in to unmask]> wrote:

> I think this is an excellent question, and one I've struggled with a few
> times in the past.
> It strikes me that hypothermia is so much less common than fever in
> neonates -- at least as a finding during ED presentation -- which is why it
> does not come up very often for discussion.
> The way James describes this case, the baby "looked fine in the ED" --
> which is why I would also hesitate to "pull the trigger" on an automatic
> SBI workup just because of the temperature alone -- unless I'd observed the
> baby for a while, had the parent feed him/her, and repeated the temperature
> again later.  Both for the baby's sake as well as the parents' sake.
> In the past when I've found myself with this dilemma, I've called the NICU
> to get input from a neonatologist -- the problem being that their practice
> setting and patient population is so different from ours in the ED, and I'm
> not sure they have an answer to this question either.
> The most consistent answer I've gotten is < 36 C, which makes some sense to
> me as it's 1 degree C under average / normal of 37 C, just like we use 38 C
> (100.4 F) as the criteria for automatic SBI workup for elevated temperature.
> However, we all know these criteria are arbitrary, so *James' question is*:
> 1) Is there either literature to support a specific low temperature
> criteria to trigger an ED SBI workup in neonates 28 days or less, in the
> absence of other specific reasons (like ill-appearance), as there is for
> fever (38 C, or 100.4 F)?; or
> 2) Is there at least consensus within PEM for what arbitrary low
> temperature to use?
> (I suspect the answer to both of these questions is "no".)
> 
> Peter Auerbach
> Randall Children's Hospital
> Portland, OR
> 
> 
> On Wed, Feb 26, 2014 at 10:11 AM, james reingold
> <[log in to unmask]>wrote:
> 
>> Hello List,
>> An interesting debate has broken out in our department over hypothermia in
>> infants 0-30 days of age.  The case in question was a 4d old who presented
>> for jaundice and was noted to have a temp of 36.2C rectal in triage, 35.8C
>> rectal when moved to the exam room.  The mother said the baby had been
>> feeding poorly and wasn't very active but the baby looked fine in the ED.
>> Some docs have said they would perform a full r/o sepsis eval.  Others
>> have felt that as an isolated finding the low temp was not worth pulling
>> the trigger since the child had a normal exam otherwise.
>> Specific questions:
>> 1.  What is hypothermia in this age group?  Some have cited <36.5, other
>> <36.02.  Is hypothermia as iron-clad an indication for r/o sepsis as fever?
>> We perform the r/o sepsis eval for 100.4F or greater even if everything
>> else is perfectly fine.  Is it the same for hypothermia?3.  Does the
>> complaint of jaundice, which we know can be caused by infection, change
>> anyone's approach to the low temp?
>> Appreciate everyone's expertise and input.
>> Thanks!
>> James Reingold, M.D.
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>> 
> 
> 
> 
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For more information, send mail to [log in to unmask] with the message: info PED-EM-L
The URL for the PED-EM-L Web Page is:
                 http://listserv.brown.edu/ped-em-l.html