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Fever Without an Apparent Source in Young Infants: A Multicenter Retrospective Evaluation of Adherence to the Dutch

Nikki N Klarenbeek1, Maya Keuning1,2,3, Jeroen Hol4

  • 1From the Department of Pediatrics, Tergooi Hospital, Blaricum, The Netherlands.

The Pediatric Infectious Disease Journal
|August 29, 2020
PubMed
Abstract

Insights

Adherence to Dutch fever without an apparent source (FWS) guidelines was low in infants under 3 months. Nonadherence was common, suggesting guidelines may need revision to improve recognition and treatment of serious infections.

Area of Science:

  • Pediatrics
  • Infectious Diseases
  • Clinical Guidelines

Background:

  • Dutch fever without an apparent source (FWS) guidelines aim for early recognition and treatment of serious infections in infants.
  • Assessing adherence to these guidelines is crucial for optimizing pediatric care.

Purpose of the Study:

  • To determine adherence rates to Dutch FWS guidelines in infants younger than 3 months.
  • To identify the prevalence of serious infections within this cohort.
  • To pinpoint factors associated with nonadherence to the guidelines.

Main Methods:

  • Retrospective cohort study of 231 infants with FWS across two Dutch teaching hospitals.
  • Comparison of clinical decisions against published Dutch FWS guidelines.
  • Categorization of infants into adherence and nonadherence groups based on guideline compliance.

Main Results:

  • 51.5% of infants adhered to the Dutch guidelines; 16.0% had serious infections.
  • Serious infections were more frequent in the adherence group compared to the nonadherence group.
  • Abnormal white blood cell count was linked to nonadherence (OR 0.4, P=0.049); common nonadherence reasons included omitting urine/blood cultures and IV antibiotics.

Conclusions:

  • Significant nonadherence to Dutch FWS guidelines was observed in infants under 3 months.
  • Current guidelines may require modification to enhance adherence and improve management of fever without source cases.

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