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Febrile infants less than 3 months old: value of chest radiography
M J Heulitt1, R C Ablow, C C Santos
1Pediatric Service, St. Luke's-Roosevelt Hospital Center, New York, NY 10025.
Insights
For febrile infants under 3 months, chest X-rays are often used. This study found X-rays are only necessary if infants show signs of respiratory distress, not for fever alone.
Area of Science:
- Pediatrics
- Radiology
- Infectious Disease
Background:
- Febrile infants under 3 months often undergo chest radiography to determine fever etiology.
- The necessity of routine chest X-rays in this population requires evaluation.
Purpose of the Study:
- To assess the necessity of obtaining chest radiographs in febrile infants younger than 3 months.
- To determine if clinical signs of respiratory distress predict pneumonia in this age group.
Main Methods:
- Retrospective review of clinical records and chest radiographs of 192 febrile infants (rectal temperature > 100.5°F).
- Analysis of the correlation between physical examination findings (specifically respiratory distress) and chest radiograph results.
Main Results:
- Pneumonia prevalence was 6% in febrile infants under 3 months.
- In infants with respiratory distress (n=19), 7 had positive chest radiographs.
- In infants without respiratory distress (n=173), 5 had positive chest radiographs.
- Physical examination findings of respiratory distress showed 58% sensitivity and 93% specificity for pneumonia detection.
Conclusions:
- Chest radiography is indicated in febrile infants less than 3 months old only when signs of respiratory distress are present.
- Routine chest X-rays for fever without respiratory distress in this age group may not be necessary.
- Physical examination is a valuable tool in guiding the need for chest radiography in febrile infants.
Abstract:
In the febrile infant less than 3 months old, a chest radiograph is commonly obtained to identify the cause of the fever. The purpose of this study was to evaluate the necessity of obtaining chest radiographs in this population. The clinical records and chest radiographs of 192 febrile infants (greater than 100.5 degrees F, rectal) were reviewed. Nineteen patients had signs of respiratory distress; seven had positive findings on chest radiographs. Of the 173 patients without signs of respiratory distress, five had positive findings on chest radiographs. When chest radiography was considered the gold standard for the presence or absence of pneumonia, findings of respiratory distress on physical examination had a sensitivity of 58% and a specificity of 93% for the detection of pneumonia. The prevalence of positive findings on chest radiographs in febrile infants less than 3 months old was 6%. A chest radiograph should be obtained in febrile infants only when signs of respiratory distress are present.