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Hypothermia may explain why Toronto newborn was wrongly pronounced dead

It's a critical tenet of emergency medicine that you're not dead until you're warm and dead.

The principle appears to explain the seemingly miraculous recovery of a newborn baby girl who was mistakenly pronounced dead at a Toronto hospital after being born outdoors in frigid weather on Sunday. Almost two hours later, as two police officers waited for a coroner's representative to pick up her body, one noticed a slight movement under a sheet covering her and detected a pulse.

"Hypothermia can mimic death," said Jamie Hutchison, research director for critical care medicine at the Hospital for Sick Children who also studies hypothermia therapies. "Temperature is an important factor when you're determining death."

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The newborn's case is similar to a host of others involving young children who have been revived after seemingly freezing to death after wandering outdoors in wintry weather. In 2001, for instance, 13-month-old Erika Nordby was resuscitated after spending up to several hours in subzero temperatures in only a T-shirt and diaper in Edmonton.

In such situations, children become hypothermic, which slows down their metabolism and brain activity. They slip into a deep coma, with such slow heart rates that their pulses can be undetectable, Dr. Hutchison said. While there is a risk of brain damage, a low body temperature can sometimes protect neurological function.

"The baby appears to not have any vital signs," said Dr. Hutchison, who was speaking generally. "But then when the baby is rewarmed … the vital signs come back."

The Toronto baby girl, who is now listed in fair condition at Sick Kids, was born outside near a busy northwest Toronto street in bitter temperatures – it was -14 C at the time, with a windchill of -23 C – shortly before 6 a.m. on Sunday. The infant's 20-year-old mother began walking to the hospital along with her mother after feeling unwell, a police spokeswoman said, and they called for help when it became clear that she wouldn't make it in time to deliver.

Paramedics rushed the newborn and her mother to nearby Humber River Hospital, where staff engaged in "extensive resuscitation efforts," including in the ambulance as they arrived at the facility, according to a statement from the hospital. However, the baby was pronounced dead and the coroner's office was called to retrieve her body. In keeping with police protocol, two officers waited with the seemingly dead child in a room for more than 90 minutes when one noticed that she was moving.

Humber River Hospital is reviewing "all procedures" involved in the newborn's care, according to the statement. A spokesman did not respond to interview requests.

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