Hyperthermia in Term Neonates: Profile and Factors Associated With Sepsis

Aim of the study The aim of this study was to distinguish between hyperthermia (HT) due to sepsis and environmental hyperthermia (EH) or dehydration fever (DF). Hyperthermia (HT) in neonates may be due to many reasons, common among them being environmental hyperthermia (EH), dehydration fever (DF), and sepsis. It is important to make a provisional diagnosis at presentation for better outcomes and prevent the indiscriminate use of antimicrobials. We therefore decided to study the profile of term neonates with HT and analyze which clinical or laboratory parameters are associated with the diagnosis of sepsis. Methods We enrolled term neonates admitted with HT (axillary temperature: > 37°C/99.5°F). Complete blood count, C-reactive protein (CRP), blood culture, and other relevant investigations were done for enrolled newborns. Well-appearing babies were kept under close observation and supportive care. On the occurrence of a repeat episode of HT, antibiotics were started, and a lumbar puncture was done. Babies who were not well-appearing were started on antibiotics at admission. Antibiotics were stopped in neonates who were well at 48-72 hours and had a sterile blood culture. All neonates were divided into three groups: EH, DF, and sepsis. The characteristics of neonates in the three groups were compared, and attributes associated with the diagnosis of sepsis were analyzed. Results We enrolled 90 term neonates over a period of 18 months. Sepsis, EH, and DF accounted for 42.2%, 34.5%, and 23.3% of the cases, respectively. Mean C-reactive protein (CRP) levels were significantly higher in the sepsis group. The presence of lethargy at admission, a repeat episode of HT, and elevated CRP were significantly associated with the diagnosis of sepsis. Conclusion All neonates with HT do not need to be treated as sepsis. Babies who are sick at presentation must be promptly treated with antibiotics. Well-appearing neonates with HT may be kept under close observation. A repeat episode of HT in a well-appearing neonate warrants starting antibiotics and thorough evaluation. A scoring system for the evaluation of neonates needs to be developed and validated.