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Updated: Oct 23, 2025
Protocol and Guidelines for Point-of-Care Lung Ultrasound in Diagnosing Neonatal Pulmonary Diseases Based on International Expert Consensus
Published on: March 6, 2019
Febrile infants without respiratory symptoms or sick contacts: are chest radiographs or RSV/influenza testing
Ali Ozcan1, Evelyn Laskowski2, Shashi Sahai2
1Pediatric Emergency Department, Loma Linda Hospital, 11234 Anderson St, Loma Linda, CA, 92354, USA. thealikemal@gmail.com.
Insights
In febrile infants under 60 days old with no respiratory symptoms, chest X-rays (CXRs) and rapid respiratory syncytial virus (RSV) or influenza (flu) testing showed no significant findings, suggesting routine testing is unnecessary.
Area of Science:
- Pediatrics
- Infectious Diseases
- Diagnostic Imaging
Background:
- Febrile infants under 60 days old have an 8-11% rate of serious bacterial infections.
- Pneumonia is rare (<1%) in febrile infants without respiratory symptoms, yet chest radiography (CXR) is common (30-60%).
- Data is limited on the necessity of rapid respiratory syncytial virus (RSV) and influenza (flu) testing in this specific infant population.
Purpose of the Study:
- To determine the rate of positive CXRs in febrile infants lacking respiratory symptoms and sick contacts.
- To assess the yield of RSV and flu testing in febrile infants without respiratory symptoms or known exposures.
- To evaluate the cost-effectiveness of diagnostic testing in this demographic.
Main Methods:
- A prospective study enrolled 129 febrile infants aged 7-60 days presenting to a pediatric emergency department.
- Data collected included demographics, respiratory symptoms, CXR findings, and RSV/flu test results.
- Statistical analysis was performed using SAS software.
Main Results:
- Of 129 infants, 58 had no respiratory symptoms or sick contacts.
- 36 of these 58 infants underwent CXR, with no abnormal findings.
- 48 infants were tested for RSV/flu; one tested positive for flu, and none for RSV.
- The cost of CXR and RSV/flu testing for this cohort was $19,788.
Conclusions:
- The high rate of negative CXRs supports current recommendations against routine imaging in febrile infants without respiratory symptoms.
- Low RSV/flu positivity rates suggest routine testing may not be necessary, particularly outside of flu season.
- Reducing unnecessary testing can decrease healthcare costs and radiation exposure for infants.
Background:
Serious bacterial infection rates in febrile infants < 60 days are about 8-11%. Less than 1% of febrile infants with no respiratory symptoms will have pneumonia however, chest radiography (CXR) rates remain between 30 and 60%. Rapid Respiratory Syncytial Virus (RSV) and influenza (flu) testing is common, however, there is not enough data to determine if febrile infants without any respiratory symptoms should be tested. The goal of this study is to determine the rate of positive CXR and RSV/flu results in febrile infants with no respiratory symptoms and no sick contacts.
Methods:
Well-appearing febrile infants between 7 and 60 days of age who presented to the pediatric emergency department (PED) from September 1st, 2015 through October 30th, 2017 were enrolled. Demographic data, respiratory symptoms, CXR findings and RSV/flu results were collected. SAS statistical software was used for analysis.
Results:
129 infants met enrollment criteria. Of the 129 infants, 58 (45.0%) had no respiratory symptoms and no sick contacts. Of these 58, 36 (62.1%) received a CXR and none of them had any abnormal findings, 48 (82.8%) had RSV/flu testing, no patients tested positive for RSV and only one patient tested positive for flu. Costs of CXR and RSV/flu testing for this cohort was $19,788.
Conclusion:
The absence of positive CXRs in this patient population reinforces the current recommendations that CXR is not indicated. The low incidence of RSV/flu indicate that routine testing may not be necessary in this population especially outside of the flu season. Reduced testing could decrease overall costs to the healthcare system as well as radiation exposure to this population.
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