Management of Hypothermia in Infants Post-Catheterization

Immediate Temperature Management

The American Heart Association recommends beginning active rewarming immediately using available warming devices, such as placing the infant under a radiant warmer or in a servo-controlled incubator to restore normothermia (36.5-37.5°C) 2, 3
Active rewarming should be done with continuous temperature monitoring, as unmonitored rewarming carries risk of overshoot hyperthermia, with evidence suggesting either rapid (≥0.5°C/hour) or slow (<0.5°C/hour) rewarming rates are acceptable, though evidence is insufficient to prefer one over the other 1, 5
Monitoring temperature continuously or every 15-30 minutes during rewarming is crucial to prevent iatrogenic hyperthermia (>38.0°C), which is associated with increased mortality, seizures, and neurologic injury 5

The American College of Cardiology recommends checking blood glucose immediately as hypothermia is strongly associated with hypoglycemia in infants, and treating hypoglycemia promptly per standard protocols if present 1

Avoiding hyperthermia during rewarming (temperature >38.0°C) is critical, and setting warmer temperature appropriately (typically 36.5-37.0°C for servo control) can help prevent this complication 5
The American Academy of Pediatrics suggests that thermal mattresses should not be used in term infants as they increase hyperthermia risk 4

Continuous assessment is essential throughout the rewarming process, including temperature monitoring every 15-30 minutes until stable normothermia is achieved, ongoing glucose monitoring, and assessment of feeding tolerance and activity level 1, 4, 5

The American Heart Association advises against delaying rewarming while investigating the cause of hypothermia, and instead recommends beginning warming immediately 1
Excessively high warmer settings should be avoided, as this increases hyperthermia risk, which carries its own morbidity 5, 4