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Which febrile infants younger than two weeks of age are likely to have sepsis? A pilot study
1Department of Pediatrics, Albert Einstein College of Medicine, Bronx, NY.
Insights
Clinical assessment combined with lab tests effectively identifies sepsis risk in febrile infants. This approach helps differentiate high-risk neonates requiring prompt treatment from low-risk infants, improving diagnostic accuracy for early sepsis detection.
Area of Science:
- Neonatal Medicine
- Pediatric Infectious Diseases
- Clinical Diagnostics
Background:
- Febrile infants younger than 2 weeks present a diagnostic challenge for sepsis.
- Early and accurate sepsis diagnosis is critical for neonatal outcomes.
- Distinguishing true sepsis from benign febrile illness is essential.
Purpose of the Study:
- To evaluate a risk stratification method for neonatal sepsis.
- To assess the utility of clinical impression, white blood cell count, and erythrocyte sedimentation rate in identifying sepsis risk.
- To determine if this risk stratification can predict bacterial complications.
Main Methods:
- Prospective study of 46 febrile infants (<2 weeks old).
- Clinical impression of sepsis recorded before laboratory evaluation.
- Risk group assignment (high/low) based on impression, WBC, and ESR.
- All infants received antibiotics and were hospitalized.
Main Results:
- Sepsis or meningitis diagnosed in 8.7% of infants.
- Significantly higher sepsis/meningitis rates in high-risk (3/11) vs. low-risk (0/24) infants (P=0.025).
- Bacterial complications developed in 3/4 high-risk infants vs. 1/17 low-risk infants (P=0.012).
Conclusions:
- A combined approach of clinical assessment and laboratory markers effectively stratifies sepsis risk in febrile neonates.
- This risk stratification aids in identifying infants at higher risk for sepsis and subsequent bacterial complications.
- The findings support the use of this method for guiding management decisions in febrile infants.
Abstract:
During a 7-year period we prospectively studied 46 infants younger than 2 weeks of age with rectal temperatures of 100.6 degrees F or higher. Before performing a full laboratory evaluation for sepsis, house officers recorded their impressions of whether the infants were likely to have sepsis. Using the combination of impression of sepsis, white blood cell count and erythrocyte sedimentation rate, infants were assigned to one of two sepsis risk groups (high or low). All patients were hospitalized and treated with parenteral antibiotics. Sepsis or meningitis was diagnosed in 8.7% of the patients. Thirty-five of the 46 infants had sufficient data for risk group assignment. Sepsis or meningitis was diagnosed in 3 of 11 high risk infants vs. 0 of 24 low risk patients (P = 0.025). Of the 21 infants initially admitted without an identified bacterial source, 4 subsequently developed a bacterial complication, i.e. a bacterial focus that, although present at the time of admission, became apparent only after hospitalization. A bacterial complication was identified during the hospital course in 3 of 4 high risk infants vs. 1 of 17 low risk patients (P = 0.012).