Successful resuscitation of the hypothermic child requires rapid attention to supportive care (airway, breathing, circulation), assessment and treatment of injury or medical conditions, and rewarming interventions that vary depending on the degree of hypothermia and the presence or absence of circulation (table 1). In addition, important modifications to advanced cardiac life support are suggested for patients with moderate or severe hypothermia. Although generally harmful, severe hypothermia may also provide cerebral protection against anoxia, allowing cases of remarkable survival after cardiac arrest [1-5].
This article discusses the treatment of unintentional hypothermia in children. The clinical manifestation of hypothermia in children, neonatal hypothermia, and frostbite are discussed separately. (See "Clinical manifestations of hypothermia in children" and "Short-term complications of the premature infant", section on 'Hypothermia' and "Frostbite".)
DEFINITION OF HYPOTHERMIA
Hypothermia is defined as a core body temperature below 35ºC (95ºF). The stage of hypothermia, defined by core temperature, has a large impact on both recognition and treatment. The most commonly used definitions found in the literature are as follows [6-8]:
- Mild – Core temperature 32° to 35ºC (90° to 95ºF)
- Moderate – Core temperature 28° to 32ºC (82° to 90ºF)
- Severe – Core temperature below 28ºC (82ºF)
In addition, some experts regard a core temperature <20ºC (68ºF) as profound hypothermia.