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Management and Outcomes of Previously Healthy, Full-Term, Febrile Infants Ages 7 to 90 Days
Tara L Greenhow1, Yun-Yi Hung2, Robert H Pantell3
1Kaiser Permanente Northern California, San Francisco, California; tara.greenhow@kp.org.
Insights
Fever in young infants is common, but cultures are often not obtained, especially in older infants. Fortunately, serious infections like bacteremia or meningitis were not identified in this study.
Area of Science:
- Pediatrics
- Infectious Diseases
- Clinical Practice
Background:
- Significant variability exists in managing febrile infants without a clear source of infection.
- Current clinical practices for obtaining cultures in young febrile infants vary widely.
Purpose of the Study:
- To describe current clinical practices for culture acquisition in febrile infants.
- To review outcomes for febrile infants with and without cultures.
Main Methods:
- Retrospective analysis of electronic medical records from Kaiser Permanente Northern California.
- Inclusion of full-term, previously healthy infants aged 7 to 90 days presenting with fever between 2010 and 2013.
Main Results:
- 1.4% of infants in the cohort presented with fever.
- Culture acquisition varied by age, with younger infants (7-28 days) more likely to have cultures than older infants (61-90 days).
- 1% of infants returned with a urinary tract infection within 30 days; no cases of bacteremia or meningitis were reported.
Conclusions:
- A substantial proportion of febrile infants, particularly those under 28 days, did not have cultures obtained.
- No delayed identification of serious infections like bacteremia or meningitis occurred in this cohort.
- Clinical practice for fever workup in infants shows considerable variation, with lower rates of culture in older infants.
Background:
There is considerable variation in the approach to infants presenting to the emergency department and outpatient clinics with fever without a source. We set out to describe the current clinical practice regarding culture acquisition on febrile young infants and review the outcomes of infants with and without cultures obtained.
Methods:
This study analyzed Kaiser Permanente Northern California's electronic medical record to identify all febrile, full term, previously healthy infants born between July 1, 2010, and June 30, 2013, presenting for care between 7 and 90 days of age.
Results:
During this 3-year study, 96 156 full-term infants were born at Kaiser Permanente Northern California. A total of 1380 infants presented for care with a fever with an incidence rate of 14.4 (95% confidence interval: 13.6-15.1) per 1000 full term births. Fifty-nine percent of infants 7 to 28 days old had a full evaluation compared with 25% of infants 29 to 60 days old and 5% of infants 61 to 90 days old. Older infants with lower febrile temperatures presenting to an office setting were less likely to have a culture. In the 30 days after fevers, 1% of infants returned with a urinary tract infection. No infants returned with bacteremia or meningitis.
Conclusions:
Fever in a medical setting occurred in 1.4% of infants in this large cohort. Forty-one percent of febrile infants did not have any cultures including 24% less than 28 days. One percent returned in the following month with a urinary tract infection. There was no delayed identification of bacteremia or meningitis.
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