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Clinical markers of serious illness in young infants: a multicentre follow-up study
P Hewson1, Z Poulakis, F Jarman
1Department of Paediatrics, Geelong Hospital, University of Melbourne, Melbourne, Victoria, Centre for Community Child Health, University of Melbourne, Royal Children's Hospital, Melbourne, Victoria. phewson@tpg.com.au
Insights
This study validated key markers for serious infant illness, confirming that drowsiness, pallor, breathing difficulty, fever, and lumps reliably identify sick infants under six months. These findings enhance early detection of critical conditions in young children.
Area of Science:
- Pediatrics
- Emergency Medicine
- Neonatology
Background:
- Early identification of serious illness in infants is crucial for timely intervention.
- Previous studies identified several clinical markers but required further validation.
Purpose of the Study:
- To validate previously identified clinical markers for serious illness in infants.
- To assess the statistical reliability and predictive value of these markers in a multicenter setting.
Main Methods:
- A 12-month prospective study of infants (1 week to 26 weeks) in emergency departments.
- Documented 11 clinical markers and temperature by nursing and medical staff.
- Defined serious illness by positive bacterial cultures, chest X-ray, or significant hospital treatment.
Main Results:
- 3806 assessments were conducted; 8.2% of infants were seriously ill.
- A combination of drowsiness, pallor, chest wall recession, fever (>38°C), and lumps identified 82.5% of seriously ill infants.
- The positive predictive value for febrile, drowsy, and pale infants was 70.7%.
Conclusions:
- Arousal variables, pallor, and chest wall recession are highly predictive of serious illness in infants.
- Fever in conjunction with these signs further increases their diagnostic utility.
- These validated markers aid in the recognition of serious illness in infants under six months.
Objective:
To perform a multicentre follow-up study to determine if previously identified markers of serious illness in early infancy were robust and statistically reliable.
Methods:
Infants aged 1 week to 26 weeks presenting to the Emergency Departments of the Royal Children's Hospital and two Melbourne metropolitan hospitals were seen over a 12-month period. Eleven clinical markers as well as their temperature were documented by nursing staff and resident medical officers. Serious illness was defined if infants had a positive body fluid bacterial culture, a positive chest X-ray or if significant treatment was required in hospital. The predictive values, sensitivity and specificity for the individual and the best combination of clinical markers were determined.
Results:
Assessments (3806) were performed with 312 infants being assessed as seriously ill (8.2%). The combination of either drowsiness on history or examination, pallor on history or examination, breathing difficulty (chest wall recession), temperature above 38 degrees C and a lump being present, identified 82.5% of all babies deemed subsequently to be seriously ill. The positive predictive value of an infant who was febrile, drowsy and pale on examination was 70.7% (previous study 74%).
Conclusions:
This study confirmed the high individual predictive value of arousal variables, pallor, and chest wall recession, especially when associated with fever, reaffirming their utility in the recognition of serious illness in infants under 6 months of age.