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Fever Characteristics and Risk of Serious Bacterial Infection in Febrile Infants
1Department of Emergency Medicine, Penn State Health Milton S. Hershey Medical Center, Hershey, Pennsylvania.
Insights
Higher fever height in infants is linked to a greater risk of serious bacterial infection (SBI). Fever duration and location are less reliable indicators of SBI risk in children.
Area of Science:
- Pediatric Emergency Medicine
- Infectious Diseases
- Clinical Pediatrics
Background:
- Fever is a frequent pediatric emergency department (ED) complaint, but serious bacterial infections (SBI) are rare in most children.
- However, undiagnosed SBI in neonates can lead to severe complications.
Purpose of the Study:
- To investigate the relationship between specific fever characteristics and the likelihood of SBI in infants.
- To identify key indicators for assessing SBI risk in febrile infants.
Main Methods:
- Secondary analysis of a prospective study involving 4821 febrile infants across 26 EDs (2008-2013).
- Examined the association of fever height, temperature measurement location (ED vs. home), and fever duration with SBI.
- Included infants with at least one completed blood culture.
Main Results:
- A higher fever height was significantly associated with an increased risk of SBI (OR 1.5; 95% CI 1.2-1.8).
- Fever duration showed no significant association with SBI risk.
- Temperature measured in the ED had a minimal association with SBI risk compared to home measurements (OR 1.3; 95% CI 1.0-1.5).
Conclusions:
- Fever height is a key indicator associated with the three major types of SBI in febrile infants.
- Fever duration and location are less reliable predictors of SBI risk.
- A slightly increased SBI risk was noted for fevers measured in the ED versus at home.
Background:
Fever is a common complaint in the pediatric emergency department (ED), but the vast majority of children evaluated with fever do not have a serious bacterial infection (SBI). However, in the neonate, a missed SBI can have devastating consequences.
Objectives:
To determine the association between various fever characteristics and the risk of SBI in febrile infants.
Methods:
This is a secondary analysis of the Pediatric Emergency Care Applied Research Network study on febrile infants. Infants with a fever were prospectively enrolled at 26 enrolling EDs between 2008 and 2013. We analyzed association of height of fever, location of where temperature was taken (enrolling ED vs. non-health care location), and duration of fever with SBI.
Results:
We included 4821 patients who had at least a blood culture completed. Height of fever was significantly associated with risk of SBI, with an odds ratio of 1.5 (95% confidence interval 1.2-1.8). Duration of fever was not associated with risk of SBI, and a fever taken in the enrolling ED vs. at a non-health care facility was minimally associated with risk of SBI (odds ratio 1.3, 95% confidence interval 1.0-1.5).
Conclusion:
In all analyses, height of fever was associated with all three major types of SBI in febrile infants. Duration and location of fever were less reliably associated with risk of SBI, but there was a small association of risk of SBI and a fever taken at the enrolling ED vs. at a non-health care location.
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