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Hyperpyrexia and high fever as a predictor for serious bacterial infection (SBI) in children-a systematic review

Noa Rosenfeld-Yehoshua1,2, Shiri Barkan3,4, Ibrahim Abu-Kishk5,3

  • 1Pediatric Intensive Care Unit, Assaf Harofeh Medical Center, Zerifin, Israel. Rosenfeldnoa@gmail.com.

European Journal of Pediatrics
|February 2, 2018
PubMed

Insights

High fever in young infants significantly increases the risk of serious bacterial infection (SBI). However, older children with high temperatures face minimal risk of SBI, according to this systematic review.

Area of Science:

  • Pediatrics
  • Infectious Diseases
  • Epidemiology

Background:

  • The association between high fever and serious bacterial infection (SBI) in children is not fully established.
  • Previous studies, primarily from the 1970s and 1980s, suggested a link between hyperpyrexia and increased SBI risk in young infants.

Purpose of the Study:

  • To systematically review and synthesize evidence on whether children with high fever are at increased risk for SBI.
  • To compare the incidence of SBI in children with hyperpyrexia versus those with lower-grade fevers.

Main Methods:

  • Systematic review of cohort and case-control studies from Embase, Medline, and Pubmed up to March 2017.
  • Two independent reviewers extracted data and calculated odds ratios (OR) with 95% confidence intervals (CI) using a random-effects model.
  • Sub-group analysis was performed to differentiate risk based on age and temperature thresholds.

Main Results:

  • Eleven studies met inclusion criteria.
  • Children with hyperpyrexia showed a higher risk of SBI (OR 1.96, 95% CI 1.3-1.97).
  • Infants with temperatures over 40°C had a significantly higher risk of SBI (OR 6.3, 95% CI 4.44-8.95), while older children showed only a slight increase in risk.

Conclusions:

  • Young infants under 3 months with temperatures exceeding 40°C are at an elevated risk for serious bacterial infections.
  • The risk of SBI in older children with temperatures above 40°C is minimal.
  • High heterogeneity and a small number of studies were noted limitations.

Keywords:
High feverHigh temperatureHyperpyrexiaInfantMeningitisPediatricPneumoniaPyelonephritisSBISerious bacterial infection (SBI)UTI

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