Temperature Elevation During Neonatal and Pediatric Fixed Wing Transport in a Subtropic Climate: A Descriptive Study

We sought to describe the degree of temperature elevation (∆T) among children transported in a subtropical climate (Florida) via fixed wing aircraft and identify potential relationships between patient weight and ∆T. We performed a retrospective cohort study in children < 18 years of age undergoing interfacility transport via fixed wing aircraft from January 2016 through July 2020. The study outcomes were ∆T, maximum patient temperature, ambient temperature, and heat index. Bivariate cohorts defined by patient weight (5 kg) were compared using Fisher exact, Student t-, and Wilcoxon rank sum analyses. Exploratory testing included receiver operator characteristic curve analyses and unadjusted logistic regression. Of the 58 children studied, 25 (43%) were ≤ 5 kg, and 33 (57%) were > 5 kg. Compared with children > 5 kg, those ≤ 5 kg had greater ∆T (0.8° ± 0.6°C vs. 0.2° ± 0.3°C), maximum patient temperature (37.3° ± 0.6°C vs. 36.8° ± 0.4°C), and proportion with ≥ 1°C ∆T (36% vs. 3%). No child > 5 kg had a temperature > 38°C, and no differences were observed for heat index or ambient temperature. Receiver operating characteristic analysis of patient weight on ∆T ≥ 1°C yielded an area under the curve of 0.86 (cutoff of 3.5 kg; sensitivity = 81.3%, specificity = 80%). Patient weight was inversely associated with ∆T ≥ 1°C (odds ratio = 0.69; 95% confidence interval, 0.49-0.96). Young children appear at greatest risk for developing environmental hyperthermia during interfacility fixed wing transport.