Paeds Cases · fetal-neonatal-and-perinatal
The cold preterm on admission — moderate hypothermia with hypoglycaemia
OSCE on a 28-week preterm infant who arrives in the neonatal unit at 35.0 C with a glucose of 1.6 mmol/L, testing the WHO classification, the four heat-loss pathways, the metabolic cascade, active external rewarming, glucose correction, and the delivery-room warm chain and plastic wrap.
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MRCPCH ClinicalRACP DCERCPSC Pediatrics
Prompt
A 28-week, 950 g infant is delivered by emergency caesarean in a cool delivery room and arrives in the neonatal unit 15 minutes after birth, wrapped in a damp towel, pale and grunting. The axillary temperature is 35.0 C and the bedside glucose is 1.6 mmol/L; the candidate must classify the temperature by the WHO band, explain why the preterm loses heat fastest, describe the metabolic cascade, give active external rewarming with glucose correction, and state the delivery-room prevention bundle.
Clinical information for the examiner
Setting: Tertiary neonatal unit, 15 minutes after birth by emergency caesarean for preterm labour. The delivery room was noted to be cool (below 25 C). The infant was wrapped in a towel that is now damp. No plastic wrap was used; no hat was applied. [1]
On your arrival:
- Axillary temperature 35.0 C; infant is pale, grunting, with mild subcostal recession. [9]
- Heart rate 150, SpO₂ 90% in air, capillary refill 3 seconds, peripherally cool. [9]
- Bedside glucose 1.6 mmol/L. [9]
References5ShowHide
- [1]Aziz K Part 5: Neonatal Resuscitation 2020 American Heart Association Guidelines for Cardiopulmonary Resuscitation and Emergency Cardiovascular Care. Pediatrics, 2021.PMID 33087555
- [3]McCall EM Interventions to prevent hypothermia at birth in preterm and/or low birth weight infants. Cochrane Database Syst Rev, 2018.PMID 29431872
- [4]Abiramalatha T Delivery Room Interventions for Hypothermia in Preterm Neonates: A Systematic Review and Network Meta-analysis. JAMA Pediatr, 2021.PMID 34028513
- [9]Hogeveen M Hypothermia and Adverse Outcomes in Very Preterm Infants: A Systematic Review. Pediatrics, 2025.PMID 40262762
- [10]Lamary M Neonatal Golden Hour: a review of current best practices and available evidence. Curr Opin Pediatr, 2023.PMID 36722754