# Refractory Bradycardia and Unreactive Mydriasis Revealing Severe Intraoperative Neonatal Hypothermia in a Resource-Limited Setting

## TL;DR

A newborn undergoing surgery developed severe hypothermia, showing symptoms like slow heart rate and unreactive pupils, which were reversed with proper treatment.

## Contribution

The paper highlights a rare clinical triad of signs for diagnosing neonatal hypothermia in resource-limited settings.

## Key findings

- Severe hypothermia in a neonate presented with refractory bradycardia, mydriasis, and chest wall rigidity.
- Active rewarming and supportive care led to full recovery of the patient.
- The case emphasizes early recognition of hypothermia signs in low-resource environments.

## Abstract

Perioperative hypothermia represents a major complication in pediatric anesthesia, particularly in neonates. We report the case of a newborn who underwent general anesthesia for esophageal fistula repair (following primary repair of esophageal atresia) and developed severe hypothermia manifested by the triad of refractory severe bradycardia, bilateral areflexic mydriasis, and chest wall rigidity. Management combining active rewarming, alkalinization, and cardiovascular support resulted in a complete recovery with a progressive normalization of clinical parameters. We discuss the clinical signs observed during this complication and draw the attention of anesthesiologists practicing in resource-limited settings, for whom these signs may enable early diagnosis of this complication.