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Severity of disease correlated with fever reduction in febrile infants
R C Baker1, T Tiller, J C Bausher
1Division of Ambulatory and Community Pediatrics, Children's Hospital Medical Center, Cincinnati, OH 45229-2899.
Insights
Fever reduction does not reliably indicate the absence of bacteremia (bacterial infection) in infants. However, a lack of clinical improvement after fever reduction may suggest meningitis, a serious infection.
Area of Science:
- Pediatrics
- Infectious Diseases
- Clinical Medicine
Background:
- Occult bacteremia is a concern in febrile infants.
- Assessing clinical improvement after fever reduction is common practice.
Purpose of the Study:
- To evaluate if clinical improvement after fever reduction differentiates bacteremic infants from those with benign viral illness.
- To determine if defervescence reliably indicates the absence of bacteremia.
Main Methods:
- Prospective study of 154 infants at risk for occult bacteremia.
- Clinical assessment before and after fever reduction with acetaminophen.
- Comparison of clinical appearance between bacteremic and non-bacteremic infants.
Main Results:
- No difference in temperature reduction with acetaminophen between groups.
- Infants with bacteremia (without meningitis) showed no clinical improvement difference post-defervescence.
- All infants with meningitis appeared seriously ill before and after fever reduction.
Conclusions:
- Clinical improvement with fever reduction is unreliable for diagnosing occult bacteremia.
- Lack of clinical improvement post-defervescence may indicate meningitis.
- Acetaminophen administration can interfere with clinical evaluation of febrile infants.
Abstract:
A prospective study of the effects of fever reduction on the clinical appearance of infants at risk for occult bacteremia was undertaken to study the hypothesis that infants with bacteremic illness fail to improve clinically following defervescence compared with infants with benign viral illness. A total of 154 children were enrolled in the study, including 19 with bacteremia: 13 with occult Streptococcus pneumoniae bacteremia, two with occult Haemophilus influenzae, type b bacteremia, and four with Haemophilus meningitis and bacteremia. There were no differences in degree of temperature reduction with acetaminophen between the bacteremic and nonbacteremic groups of infants. Among infants with bacteremia but without meningitis, differences from nonbacteremic children were detected in clinical appearance prior to fever reduction but not following defervescence. All patients with meningitis appeared seriously ill before and after defervescence. It was concluded that clinical improvement with defervescence is not a reliable indicator of the presence of occult bacteremia. Lack of clinical improvement with defervescence may be a reliable indicator for the presence of meningitis. Because there were differences in clinical appearance prior to fever reduction, routine administration of acetaminophen may interfere with the clinical evaluation by the physician.