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Updated: Apr 14, 2026
A Neonatal Imaging Model of Gram-Negative Bacterial Sepsis
Published on: August 12, 2020
Predictors of time to recovery in infants with probable serious bacterial infection
Prashant Singh1, Nitya Wadhwa1, Rakesh Lodha2
1Translational Health Science and Technology Institute, Gurgaon, India; Department of Pediatrics, All India Institute of Medical Sciences, New Delhi, India.
Insights
Formula feeding, being underweight, lethargic, irritable, and high CRP levels predict longer recovery times in infants with serious bacterial infections. These factors aid early identification and management in resource-limited settings.
Area of Science:
- Pediatrics
- Infectious Diseases
- Global Health
Background:
- Serious bacterial infections (PSBI) are a major cause of infant mortality in developing countries.
- Time to recovery serves as a marker for infection severity.
- Predicting recovery time is crucial for managing infant health outcomes.
Purpose of the Study:
- To identify clinical and laboratory predictors of recovery time in infants with probable serious bacterial infection (PSBI).
- To understand factors influencing the duration of illness in infants with PSBI.
- To inform management strategies in resource-limited settings.
Main Methods:
- A randomized controlled trial dataset of 700 infants (7-120 days) in India was analyzed.
- PSBI was defined by clinical signs and elevated C-reactive protein (CRP >12mg/L).
- Cox proportional hazard regression assessed predictors of time to recovery, defined by symptom resolution and weight gain.
Main Results:
- Infants formula-fed before illness had 33% longer recovery times.
- Being underweight, lethargic, or irritable independently predicted longer recovery.
- Higher baseline CRP levels were significantly associated with prolonged recovery time.
Conclusions:
- Clinical factors (formula feeding, underweight, lethargy, irritability) and elevated CRP predict protracted illness in infants with PSBI.
- These predictors can guide early identification and referral in resource-limited settings.
- Identifying infants at risk for longer recovery has significant economic and social implications for families.
Introduction:
Serious bacterial infections continue to be an important cause of death and illness among infants in developing countries. Time to recovery could be considered a surrogate marker of severity of the infection. We therefore aimed to identify clinical and laboratory predictors of time to recovery in infants with probable serious bacterial infection (PSBI).
Methods:
We used the dataset of 700 infants (7-120 days) enrolled in a randomised controlled trial in India in which 10mg of oral zinc or placebo was given to infants with PSBI. PSBI was defined as signs/symptoms of possible serious bacterial infection along with baseline C-reactive protein(CRP) level >12mg/L. Time to recovery was defined as time from enrolment to the end of a 2-day period with no symptoms/signs of PSBI and daily weight gain of at least 10g over 2 succesive days on exclusive oral feeding. Cox proportional hazard regression was used to measure the associations between relevant variables and time to recovery.
Results:
Infants who were formula fed prior to illness episode had 33% longer time to recovery (HR-0.67, 95%CI-0.52, 0.87) than those who were not. Being underweight (HR-0.84, 95%CI-0.70, 0.99), lethargic (HR-0.77, 95%CI-0.62, 0.96) and irritable (HR-0.81, 95%CI-0.66, 0.99) were independent predictors of time to recovery. Baseline CRP was significantly associated with time to recovery (P<0.001), higher CRP was associated with longer time to recovery and this association was nearly linear.
Conclusion:
Simple clinical and laboratory parameters such as formula feeding prior to the illness, being underweight, lethargic, irritable and having elevated CRP levels could be used for early identification of infants with PSBI at risk for protracted illness and could guide prompt referral to higher centers in resource limited settings. This also provides prognostic information to clinicians and family as longer recovery time has economic and social implications on the family in our setting.
Trial Registration:
ClinicalTrials.gov NCT00347386.
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