Assessing the Significance of Hyperthermia in Newborns Undergoing Phototherapy for Hyperbilirubinemia

About 2% of full-term neonates are evaluated for fever, with serious bacterial infections (SBIs) identified in roughly 10% of cases. The 2021 American Academy of Pediatrics guideline standardizes febrile neonate evaluation, but factors like phototherapy for hyperbilirubinemia can complicate decisions. Phototherapy-associated hyperthermia raises concern about distinguishing environmental causes from true infection. This study assessed the prevalence of hyperthermia in neonates receiving phototherapy and its association with SBI.

We performed a retrospective chart review of neonates admitted for phototherapy at a quaternary pediatric hospital (2019-2022). Using International Classification of Diseases codes, we identified patients with hyperthermia (≥38°C) and reviewed whether they underwent SBI evaluation and follow-up within 2 weeks.

Among 639 neonates, 9 (1.4%) developed hyperthermia. Two (22%) were diagnosed with an SBI; one had a negative SBI workup, and six were not further evaluated. None of the seven without SBI returned for care. The 1.4% hyperthermia rate is not higher than the general neonatal fever prevalence (2%).

Hyperthermia during phototherapy is uncommon, but the 22% SBI rate in febrile neonates is noteworthy. Elevated temperatures in this context should not be presumed to be environmental. Clinicians should maintain vigilance and consider full SBI evaluations.

Consider SBIs in febrile neonates on phototherapy; do not attribute fever to environmental factors.Phototherapy rarely causes fever; while it warms infants, it does not raise fever risk.Standardized approaches reduce variability in fever care.