Predicting outcome after near-drowning has been extensively studied. During four years, 42 near drowned children were aggressively treated with positive pressure ventilation, barbiturates and hypothermia. This mode of treatment makes it difficult to clinically assess the child's prognosis. Temperature instability after rewarming is an early negative predictive factor following treatment of near-drowning, and in conjunction with cerebral flow studies avoids the potential commitment to prolonged and unwarranted cardiovascular and respiratory support.