This week’s case highlights the difficulty of interpreting hypothermia in an infant as environmental vs. sepsis. We discussed clinical clues such as the patient being well appearing (less likely to do work-up) and lower levels of risk tolerance in neonates/newborns (more likely to do a work-up). We also discussed what a work-up would entail and the utility of labs such as a procalcitonin. If a patient is discharged we discussed the importance strict return precautions and potential risks of not doing a work-up with a parent.

While the hypothermia resolved and the patient was able to remain euthermic, further management options were discussed with the mother through shared decision-making and she elected to proceed with further laboratory investigation. We obtained an SBI work-up which included a CBC with diff, BMP, procalcitonin, Blood Culture, and HSV1/2 serum PCRs, given hypothermia. Work-up was all normal besides a non-specific lymphocytosis and patient was discharged home.

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