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This came up the other day in the ED. One particular community office frequently sends in 1 week olds for evaluation due to 'temp instability' or 'hypothermia.' Basically they come in for a newborn check and have temp of 36.5 or something like that, but are otherwise fine. Of course by the time we see them, the temp is normal.
Now I know there's a concern that temp instability can be a sign of sepsis, and on some of these kids we are doing the full work up plus admission, just as if they had a temp of 38. But on others we just watch and take temps every hour for 4 hours and send home if there's no change. Each of us seems to handle it a little differently.
What do you guys do? What's your cut off for 'hypothermia' or temp instability? I use a temp less than 36, some say 36.5. More importantly, where's the supporting data?. I can't find any recommendations or studies that suggest a low temp cut off, work up recommendation, or even the incidence of sepsis. Do we perhaps overdo it in these kids, and should we maybe stop checking the them at the newborn exam?
Now I know there's a concern that temp instability can be a sign of sepsis, and on some of these kids we are doing the full work up plus admission, just as if they had a temp of 38. But on others we just watch and take temps every hour for 4 hours and send home if there's no change. Each of us seems to handle it a little differently.
What do you guys do? What's your cut off for 'hypothermia' or temp instability? I use a temp less than 36, some say 36.5. More importantly, where's the supporting data?. I can't find any recommendations or studies that suggest a low temp cut off, work up recommendation, or even the incidence of sepsis. Do we perhaps overdo it in these kids, and should we maybe stop checking the them at the newborn exam?
