hot/cold baby

[Perrotfish]

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If you have an otherwise asymptomatic <1 month baby, will you allow a period of skin to skin/cooling off in the air and take a temperature to prevent a rule out sepsis workup, or do you take them right upstairs? I feel like I hear 'he is just hot/cold because...' a lot, and I don't want to be a spa but I don't want to under read a temperature either. What do you do?

 

[AllScuttledOut]

I think a lot depends on the situation. If the temp is 38 exactly, the kid is wrapped up in a million fleece jumpers/blankets, the room is hot as heck, and they are perfect in every other way, I may be more likely to re-check. However, if the baby is in the ED, there is usually a reason that they're there (fever at home, fussiness, etc). That would buy them a ROS work-up regardless of the environment if they have a documented fever.

Disclaimer: This is just my opinion as a lowly intern.

 

[Cuthbert]

Disclaimer: This is just my opinion as a lowly intern.

It's a good opinion. I would add that (in the case of the heavily wrapped baby) you can always do a partial ROS workup. For me, that is everything minus the LP and cath UA/UC. If there are any concerns on the partial, move onto the full. Just remember, don't give any antibiotics if you did not do the full workup.

Edit: I advise new parents with the following before going home with their child: "If you are worried that your child is running a fever, undress them down to the diaper and let them air out for 10 minutes. Then take their temperature." This will typically prevent a (middle of the night) unnecessary call.

 

[BigRedBeta]

This is the sort of judgement call that will keep the machines from taking our jobs 😉

In the end, it's reading the situation - if the kid is way overbundled then yes, strip them down. If the baby is reasonably dressed, then my opinion is you do the full workup in those under 4 weeks. If they're in that 4-6 week grey area, then you do everything but the LP (in my mind if you're leaving off the UA/Cx, the baby might as well have never come in...and don't get me started on bag specimens). The CXR is lowest yield aspect of the workup. And as an intensivist, I'm compelled to remind you that a WBC <5 is a criterion for SIRS, as is hypothermia. The combination of the two means you have a diagnosis of sepsis since you have to presume it's infectious.

My own personal view is that if you're under 4 weeks old and come in for anything but constipation or noisy breathing, you're getting a needle in your back.

I don't think many parents of newborns consider a 48 hour rule out to be a "spa trip". This isn't like making soft admits at the VA as a med student.