Physical Abuse With Severe Hypothermia

Accidental hypothermia is a well-studied entity. Cerebral hypoperfusion is somewhat less damaging at temperatures under 25°C to 28°C.1 No studies of nonaccidental hypothermia have been discovered after an extensive literature search. We herein report four cases of child abuse–related hypothermia resulting from cold water immersion or exposure to low ambient temperature in inadequate clothing from our experience in two hospitals in a cold-temperature area.Report of Patients.Patient 1. A 4-year-old girl was found naked on the bathroom floor, pulseless, with a rectal temperature less than 29°C, when police and paramedics were called to the family home. She was noted to have many bruises on her body that appeared both old and new. When called for near drowning, ambulance attendants noted that the patient was dry, as was the bathroom floor, with 4.4 cm of water in the bathtub. In the emergency department, the patient was maintained on full