Assessing the Significance of Hyperthermia in Newborns Undergoing Phototherapy for Hyperbilirubinemia.

Abstract

Objective: 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.

Study design: 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.

Results: 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%).

Conclusion: 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.

Key points: 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.