Successful Resuscitation of a Severely Hypothermic Neonate

doi:10.1016/S0196-0644(94)70369-8

Annals of Emergency Medicine

Volume 23, Issue 6, June 1994, Pages 1390-1393

https://doi.org/10.1016/S0196-0644(94)70369-8 Get rights and content

Abstract

A profoundly hypothermic 5-hour-old infant in cardiac arrest was brought to the emergency department by paramedics. The infant was found wrapped in a garbage bag inside a freezer. She had been in the freezer for approximately four hours. Her initial rectal temperature was 16.2°C. Active external and core warming modalities, including warm blanket, radiant heat lamp, warm humidified air, heated gastric lavage, and heated bladder lavage, were used to rewarm the infant. Her temperature rose to 30.5°C in three hours (4.8°C/hr). The infant converted from a slow idioventricular rhythm to sinus bradycardia at 49 minutes (20.4°C) into the resuscitation. At 53 minutes (21.5°C), the infant moved both upper extremities. At the time of discharge from the hospital, she had no significant physical or neurologic problems. Neurologic examination at 4 months was normal. This report supports prior recommendations to aggressively rewarm severely hypothermic infants in cardiac arrest.

[Thompson DA, Anderson N: Successful resuscitation of a severely hypothermic neonate. Ann Emerg Med June 1994;23:1390-1393.]

Section snippets

INTRODUCTION

Severe hypothermia is defined as a core body temperature below 28°C.¹ We report the treatment of severe hypothermia in a 5-hour-old neonate with subsequent full recovery.

CASE REPORT

Approximately five hours, 20 minutes before arrival in the emergency department, a baby girl was born by normal spontaneous vaginal delivery. The estimated gestational age was 37 weeks. Allegedly, one hour after birth (4 hours, 20 minutes before arrival), the infant was wrapped in a towel, put in a plastic garbage bag, and placed inside the freezer compartment of a refrigerator. Approximately five hours after birth (20 minutes before arrival), paramedics removed the infant from the freezer.

DISCUSSION

Hypothermia is defined as a core body temperature of less than 35°C. Hypothermia has been categorized into three physiologic stages: mild, moderate, and severe. Mild hypothermia refers to core body temperatures between 32° and 35°C. Typical physiologic characteristics include normal blood pressure, shivering, apathy, and dysarthria. Moderate hypothermia refers to core body temperatures between 27° and 32°C. Patients with this degree of hypothermia typically demonstrate progressive decrease in

SUMMARY

We report the successful resuscitation of a severely hypothermic 5-hour-old infant in cardiac arrest who had been found in a freezer. Using a combination of active external and core rewarming techniques, the infant's temperature rose from 16.2°C to 30.5°C in three hours (4.8°C/hr). At time of discharge from the hospital and on subsequent follow-up, the infant was neurologically normal.

This case report supports prior recommendations that hypothermic infants in cardiac arrest should be rewarmed

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Cited by (27)

Unrecognized platelet physiology is the cause of rewarming deaths in accidental hypothermia and neonatal cold injury
2021, Medical Hypotheses
Citation Excerpt :
One example of an excellent outcome after short period of hypothermia even with cardiac arrest is the boating accident in a Norwegian Fjord [29] (see above). There are many such cases reported in neonatal cold injury , such as the neonate who was buried alive and dug up by a passing dog [8] the lifeless 20 month old infant found after 30 min submerged in a 1.1 °C creek [30] the lifeless infant found lying in a clogged city sewer with a skin temperature of 25 °C [31] and the 5 h old neonate in cardiac arrest with a rectal temperature of 16.2 °C found in a garbage bag inside a freezer [27]. All survived after a relatively short period of hyperthermia.
The lack of improvement in prognosis of accidental hypothermia and neonatal cold injury suggests that a major cause of mortality has not been appreciated.
To show that thrombocytopenia that deepens on rewarming under certain conditions is that missing factor.
Below 34 °C the first stage of aggregation is accentuated, the platelets are more sensitive to ADP and aggregation studies show an increased response “first stage hyper aggregation”. We have confirmed that the irreversible second stage of platelet aggregation does not occur below 34 °C. On rewarming, the first stage of aggregation is followed by disaggregation. When platelets are warmed to 34 °C the potential exists for the platelets to undergo an irreversible second stage of aggregation “second stage platelet hyper aggregation” that can cause a further drop in platelet count and a bleeding diathesis. This only occurs if the platelets have been sufficiently primed when cold and may not be appreciated if platelet counts are not followed.
This thesis explains many other open questions. Why has the overall prognosis remained without improvement over the last half century? Why hypothermic cardiac surgery is free of this problem? Why the depth of hypothermia is alone not prognostic? Has following platelet counts been associated with improved prognosis? Why cardiac arrest does not affect prognosis? Why some patients die suddenly after recovering from hypothermia? Why are so many different rewarming techniques used? Why is the prognosis better in hypothermic suicide attempts? What is the pathophysiological explanation for reversible sequestration of platelets to the liver and spleen in hypothermia? Is DIC (diffuse intravascular coagulation) a problem in hypothermia? And how this new approach could improve prognosis?
Prognosis can be improved by following platelet counts during rewarming. In patients with prolonged hypothermia, this will show a life-threatening drop in such counts easily treated by platelet infusion.
Management of severe accidental hypothermia
2012, Medicina Intensiva
La hipotermia accidental es una patología ambiental con unos principios básicos de clasificación y reanimación que sirven tanto para el medio montañoso, marítimo o urbano. Esta patología ha formado parte, junto a la acidosis y la coagulopatía, de la famosa «tríada letal» de las víctimas traumáticas en situación crítica. En su manejo y asistencia está implicada toda una cadena asistencial que se extiende desde la medicina de urgencia prehospitalaria hasta la medicina intensiva, llegando incluso hasta la cirugía cardiaca y/o a los programas de circulación extracorpórea.
Una buena clasificación prehospitalaria del grado de hipotermia facilitará su manejo inicial y evitará traslados interhospitalarios o secundarios innecesarios. Lo fundamental es trasladar, con la mayor urgencia posible, a las víctimas hipotérmicas en asistolia o fibrilación ventricular hasta aquellos hospitales que tengan la capacidad tecnológica adecuada para el tratamiento de estas especiales situaciones clínicas.
Este artículo, trata de sentar las bases que faciliten un manejo adecuado de la hipotermia accidental desde la primera asistencia prehospitalaria hasta tratamiento final hospitalario, incluyendo la reanimación y el recalentamiento con circulación extracorpórea.
Accidental hypothermia is an environmental condition with basic principles of classification and resuscitation that apply to mountain, sea or urban scenarios. Along with coagulopathy and acidosis, hypothermia belongs to the lethal triad of trauma victims requiring critical care. A customized healthcare chain is involved in its management, extending from on site assistance to intensive care, cardiac surgery and/or the extracorporeal circulation protocols.
A good classification of the degree of hypothermia preceding admission contributes to improve management and avoids inappropriate referrals between hospitals. The most important issue is to admit hypothermia victims in asystolia or ventricular fibrillation to those hospitals equipped with the medical technology which these special clinical scenarios require.
This study attempts to establish the foundations for optimum management of accidental hypothermia from first emergency care on site to treatment in hospital including, resuscitation and rewarming with extracorporeal circulation.
Accidental Hypothermia
2011, Pediatric Critical Care: Expert Consult Premium Edition
Accidental Hypothermia
2011, Pediatric Critical Care
Hypothermia
2008, Pediatric Emergency Medicine
Hypothermia
2007, Pediatric Emergency Medicine

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^☆: From the Emergency Department, MacNeal Hospital, Berwyn, Illinois.

^☆☆: Address for reprints: David A Thompson, MD, FACEP, Emergency Department, 3249 South Oak Park Avenue, MacNeal Hospital, Berwyn, Illinois 60402

^★: Reprint no. 47/1/55631

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Successful Resuscitation of a Severely Hypothermic Neonate☆,☆☆,★

Abstract

Section snippets

INTRODUCTION

CASE REPORT

DISCUSSION

SUMMARY

Emerg Clin North Am

J Pediatr

J Pediatr

Ann Emerg Med

J Pediatr

J Pediatr

J Pediatr

Ann Emerg Med