Pediatric Hypothermia: An Ambiguous Issue

Singer, Dominique

doi:10.3390/ijerph182111484

Cited by 17 publications

(6 citation statements)

References 94 publications

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“…Hypothermia can also be caused by conditions that impair thermogenesis or thermoregulation (secondary hypothermia, Table 1 ). Children, and small adults with low body mass indices (BMIs) are most susceptible to hypothermia because of their large body surface to weight ratios, allowing greater heat loss compared to larger individuals with normal or high BMIs [ 22 ]. Mild or moderate hypothermia can occur in in urban and rural areas in cold and moderate climates during all seasons [ 11 , 23 , 24 ].…”

Section: Pathophysiologymentioning

confidence: 99%

Accidental Hypothermia: 2021 Update

Paal

Pasquier

Darocha

et al. 2022

IJERPH

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Accidental hypothermia is an unintentional drop of core temperature below 35 °C. Annually, thousands die of primary hypothermia and an unknown number die of secondary hypothermia worldwide. Hypothermia can be expected in emergency patients in the prehospital phase. Injured and intoxicated patients cool quickly even in subtropical regions. Preventive measures are important to avoid hypothermia or cooling in ill or injured patients. Diagnosis and assessment of the risk of cardiac arrest are based on clinical signs and core temperature measurement when available. Hypothermic patients with risk factors for imminent cardiac arrest (temperature < 30 °C in young and healthy patients and <32 °C in elderly persons, or patients with multiple comorbidities), ventricular dysrhythmias, or systolic blood pressure < 90 mmHg) and hypothermic patients who are already in cardiac arrest, should be transferred directly to an extracorporeal life support (ECLS) centre. If a hypothermic patient arrests, continuous cardiopulmonary resuscitation (CPR) should be performed. In hypothermic patients, the chances of survival and good neurological outcome are higher than for normothermic patients for witnessed, unwitnessed and asystolic cardiac arrest. Mechanical CPR devices should be used for prolonged rescue, if available. In severely hypothermic patients in cardiac arrest, if continuous or mechanical CPR is not possible, intermittent CPR should be used. Rewarming can be accomplished by passive and active techniques. Most often, passive and active external techniques are used. Only in patients with refractory hypothermia or cardiac arrest are internal rewarming techniques required. ECLS rewarming should be performed with extracorporeal membrane oxygenation (ECMO). A post-resuscitation care bundle should complement treatment.

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Section: Pathophysiologymentioning

confidence: 99%

Accidental Hypothermia: 2021 Update

Paal

Pasquier

Darocha

et al. 2022

IJERPH

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“…Although Cantwell (2021) is of opinion that it is necessary to find out what the temperature of the water was, conductive heat loss that occur during submersion overturn this view, as hypothermia is normally the outcome of drowning incidents, irrespective the temperature of the water. Evidence include that lower water temperatures do not necessarily have greater neuroprotective possibilities‐better drowning outcomes relate to the sequence of the drowning event and the duration of submission and not necessarily the degree of cooling (Cantwell, 2021; Davidoff, 2021; Singer, 2021; Tipton & Montgomery, 2022). Because children have larger surface areas in relation to body volume ratios and limited subcutaneous body fat, cooling occurs quickly after cold‐water submersion.…”

Section: The Process Of Drowningmentioning

confidence: 99%

A quest for an integrated management system of children following a drowning incident: A review of the literature

Rossouw,

Maree,

Latour

2023

Specialist Pediatric Nursing

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PurposeManagement of children following a drowning incident is based on specific interventions which are used in the prehospital environment, the emergency department (ED) and the Paediatric Intensive Care Unit (PICU). This paper presents a review of the literature to map and describe the management and interventions used by healthcare professionals when managing a child following a drowning incident. Of specific interest was to map, synthesise and describe the management and interventions according to the different clinical domains or practice areas of healthcare professionals.Design and MethodsA traditional review of the literature was performed to appraise, map and describe information from 32 relevant articles. Four electronic databases were searched using search strings and the Boolean operators AND as well as OR. The included articles were all published in English between 2010 and 2022, as it comprised a timeline including current guidelines and practices necessary to describe management and interventions.ResultsConcepts and phrases from the literature were used as headings to form a picture or overview of the interventions used for managing a child following a drowning incident. Information extracted from the literature was mapped under management and interventions for prehospital, the ED and the PICU and a figure was constructed to display the findings. It was evident from the literature that management and interventions are well researched, evidence‐informed and discussed, but no clear arguments or examples could be found to link the interventions for integrated management from the scene of drowning through to the PICU. Cooling and/or rewarming techniques and approaches and termination of resuscitation were found to be discussed as interventions, but no evidence of integration from prehospital to the ED and beyond was found. The review also highlighted the absence of parental involvement in the management of children following a drowning incident.Practice ImplicationsMapping the literature enables visualisation of management and interventions used for children following a drowning incident. Integration of these interventions can collaboratively be done by involving the healthcare practitioners to form a link or chain for integrated management from the scene of drowning through to the PICU.

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“…One of the main contributing factors which underlies high rates of preventable neonatal mortality is hypothermia ( 9 – 12 ). For a variety of reasons related to underdeveloped physiology, as well as environmental conditions both within health facilities and in the home and community settings, premature, low birthweight, and small-for-gestational age newborns struggle to maintain a normal body temperature, defined as 36.5°C–37.5°C ( 13 – 15 ). Newborns have a greater surface area-to-weight ratio, larger head-to-body ratio, and less adipose tissue for insulation, predisposing them to heat loss without appropriate thermal care interventions ( 16 ).…”

Section: Introductionmentioning

confidence: 99%

Preclinical validation of NeoWarm, a low-cost infant warmer and carrier device, to ameliorate induced hypothermia in newborn piglets as models for human neonates

Bluhm,

Tomlin,

Hoilett

et al. 2024

Front. Pediatr.

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IntroductionApproximately 1.5 million neonatal deaths occur among premature and small (low birthweight or small-for gestational age) neonates annually, with a disproportionate amount of this mortality occurring in low- and middle-income countries (LMICs). Hypothermia, the inability of newborns to regulate their body temperature, is common among prematurely born and small babies, and often underlies high rates of mortality in this population. In high-resource settings, incubators and radiant warmers are the gold standard for hypothermia, but this equipment is often scarce in LMICs. Kangaroo Mother Care/Skin-to-skin care (KMC/STS) is an evidence-based intervention that has been targeted for scale-up among premature and small neonates. However, KMC/STS requires hours of daily contact between a neonate and an able adult caregiver, leaving little time for the caregiver to care for themselves. To address this, we created a novel self-warming biomedical device, NeoWarm, to augment KMC/STS. The present study aimed to validate the safety and efficacy of NeoWarm.MethodsSixteen, 0-to-5-day-old piglets were used as an animal model due to similarities in their thermoregulatory capabilities, circulatory systems, and approximate skin composition to human neonates. The piglets were placed in an engineered cooling box to drop their core temperature below 36.5°C, the World Health Organizations definition of hypothermia for human neonates. The piglets were then warmed in NeoWarm (n = 6) or placed in the ambient 17.8°C ± 0.6°C lab environment (n = 5) as a control to assess the efficacy of NeoWarm in regulating their core body temperature.ResultsAll 6 piglets placed in NeoWarm recovered from hypothermia, while none of the 5 piglets in the ambient environment recovered. The piglets warmed in NeoWarm reached a significantly higher core body temperature (39.2°C ± 0.4°C, n = 6) than the piglets that were warmed in the ambient environment (37.9°C ± 0.4°C, n = 5) (p < 0.001). No piglet in the NeoWarm group suffered signs of burns or skin abrasions.DiscussionOur results in this pilot study indicate that NeoWarm can safely and effectively warm hypothermic piglets to a normal core body temperature and, with additional validation, shows promise for potential use among human premature and small neonates.

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Pediatric Hypothermia: An Ambiguous Issue

Cited by 17 publications

References 94 publications

Accidental Hypothermia: 2021 Update

Accidental Hypothermia: 2021 Update

A quest for an integrated management system of children following a drowning incident: A review of the literature

Preclinical validation of NeoWarm, a low-cost infant warmer and carrier device, to ameliorate induced hypothermia in newborn piglets as models for human neonates

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