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Correlating reported fever in young infants with subsequent temperature patterns and rate of serious bacterial
W A Bonadio1, M Hegenbarth, M Zachariason
1Medical College of Wisconsin, Department of Pediatrics, Children's Hospital of Wisconsin, Milwaukee.
Insights
Fever in infants under two months requires careful evaluation. Rectal temperature measurements are more reliable than tactile fever for predicting subsequent fever and serious bacterial infections (SBI).
Area of Science:
- Pediatrics
- Infectious Diseases
- Neonatal Care
Background:
- Fever in young infants (under 2 months) is a common concern, often prompting evaluation for sepsis.
- Accurate assessment of fever is crucial for timely diagnosis and management of serious bacterial infections (SBI).
Purpose of the Study:
- To correlate reported fever symptoms with actual temperature patterns in hospitalized infants.
- To determine the association between fever reporting methods and the incidence of serious bacterial infections (SBI).
Main Methods:
- Retrospective study of 292 infants younger than 2 months presenting with fever.
- Categorization of fever reporting: rectal thermometer vs. tactile.
- Analysis of temperature patterns during hospitalization and rates of SBI.
Main Results:
- Infants with reported rectal fever were significantly more likely to have fever during hospitalization (92%) compared to tactile fever (46%).
- Afebrile infants with reported rectal fever had a higher incidence of subsequent fever (20%) and SBI (10%) than those with tactile fever (0% and 3.8%).
- All 19 infants with SBI had suggestive clinical/laboratory findings, even if initially afebrile.
Conclusions:
- Rectal temperature measurement is a more reliable indicator of fever in young infants than tactile assessment.
- Management decisions for febrile infants should integrate clinical findings with temperature patterns.
- Prompt evaluation is essential for all infants with fever, regardless of reporting method, to rule out SBI.
Abstract:
A retrospective study was performed of 292 infants younger than 2 months of age with a history of fever who received a standardized evaluation and were admitted to the hospital for possible sepsis. The purpose was to correlate the presence of this symptom with subsequent temperature patterns and the rate of serious bacterial infections (SBI). Caretakers reported fever per rectum via thermometer in 244 infants and tactile fever in 48 infants. Of 244 infants with reported fever per rectum, 224 (92%) had fever on presentation or during the subsequent 48 hours of hospitalization; by contrast, only 22 of 48 infants (46%) with reported tactile fever had fever on presentation or during the subsequent 48 hours of hospitalization (P less than 0.0001). Of 26 infants with tactile fever who were afebrile on presentation, none had subsequent fever during hospitalization and only 1 (3.8%) had SBI (urinary tract infection); of 40 infants with reported fever per rectum who were afebrile on presentation, 8 (20%) had subsequent fever during hospitalization and 4 (10%) had SBI (meningitis, bacteremia, osteomyelitis and urinary tract infection). There were a total of 19 infants (6.5%) with SBI; although 5 (27%) were afebrile on presentation (4 with reported fever per rectum, 1 with tactile fever), all 19 exhibited abnormal clinical and/or laboratory features on evaluation which were suggestive of underlying serious infection. Management decisions for young infants with reported fever should be based on both clinical findings and temperature-pattern profiles.