Neonatal hyperthermia may be caused by viral or bacterial infection. Neonates with severe infections could be life-threatening. However, non-infection issues may be one of the causes inducing neonatal hyperthermia in the baby room (BR). In addition, hyperthermia without other combined symptoms and signs of infections may not need more managements and treatments which may result in unnecessary hospitalization, iatrogenic injuries, and break of parent-child attachment.
This study aimed to analyze the etiologies of neonatal hyperthermia (rectal temperature higher than 38℃or axillary temperature higher than 37.3℃) in the BR, and analyze the related factors indicating the need for admiration to the sick baby room (SBR) for further managements. Moreover, we also intended to determine the optimal body temperature of newborn with hyperthermia for the SBR admission.
This study is a retrospective analysis of medical records, after the newborns were collected in a medical hospital in central Taiwan. from January 2007 to December 2013. Newborns with hyperthermia were divided into 2 groups, the BR observation and the SBR admission. All related factors between the two groups were further analyzed in this study. Receiver operating characteristic curve analysis was used to determine the optimal body temperature of newborn with hyperthermia for the SBR admission.
A total of 2,152 newborns were collected during the study period, including 92 cases with hyperthermia. Among them, 30 were admitted to the SBR with the maximum body temperature of 38.3 ± 0.23℃, and 62 were stayed in the BR for further observation with the maximum body temperature of 37.7 ± 0.19℃. Pure breast feeding, irritable crying, parental feeding, decreased appetite, vomiting, abdominal distension, decreased activity, tachypnea and tachycardia were all significantly associated with neonatal hyperthermia ha (p <0.05). Based on the results of ROC curve analysis, the area under the curve was 0.976. When body temperature of a newborn was less than 37.8℃, the newborn may stay in the BR, sensitivity 100%, specificity 61%, the positive likelihood ratio (LR+) 2.58, the negative likelihood ratio (LR-) 0. When body temperature of a newborn was higher than 38.2℃, the newborn may need to admit to the SBR, sensitivity 70%, specificity 100%, LR+∞, LR- 0.30. But, when body temperature of a newborn was 38.0℃, the newborn should be highly observed for related clinical symptoms and signs (sensitivity 93%, specificity 87%, LR+ 7.23, LR- 0.08).
The related non-infection issues clinical factors such as pure breast-feeding, irritable crying, parental feeding, decreased appetite, vomiting, abdominal distension, tachypnea and tachycardia were all associated with neonatal hyperthermia in the BR. Most importantly, once body temperature is over 38.0℃, the newborn should be closely observed for the above clinical factors to match the criteria of the SBR admission.