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Published on: August 12, 2020
The risk of serious bacterial infections among young ex-premature infants with fever
Yuval Barak-Corren1,2, Yoav Elizur3, Shira Yuval1
1The Pediatrics Department, Shaare Zedek Medical Center, Jerusalem, Israel.
Insights
Feverish ex-premature infants under 28 days adjusted age have a significant risk of invasive bacterial infection (IBI). Well-appearing infants up to 60 days adjusted age remain at risk for urinary tract infection (UTI).
Area of Science:
- Pediatrics
- Infectious Diseases
- Neonatology
Background:
- Fever in young infants can indicate serious bacterial infections (SBI).
- Ex-premature infants represent a unique population with potentially different responses to fever.
- Risk stratification for SBI in ex-premature infants is crucial for appropriate management.
Purpose of the Study:
- To determine the rate of serious bacterial infections (SBI) in young ex-premature infants presenting with fever.
- To develop a risk-stratification algorithm for identifying high-risk ex-premature infants with fever.
- To compare SBI rates in ex-premature infants to matched full-term controls.
Main Methods:
- Retrospective cohort study of infants with fever (≥38°C) born prematurely (<37 weeks) or full-term.
- Inclusion criteria: post-conception age <52 weeks, available blood, urine, or CSF cultures.
- Comparison of SBI rates between ex-premature cases and matched full-term controls between 2010-2020.
Main Results:
- Ex-premature infants had a higher rate of invasive bacterial infection (IBI) within 28 days of chronological age (3.6% vs 0%, p=0.02).
- Well-appearing ex-premature infants under 60 days adjusted age showed a significant risk for IBI (3%) and UTI (10.6%).
- Urinalysis was unreliable for excluding UTI in ex-premature infants under 60 days adjusted age (50% negative).
Conclusions:
- Well-appearing ex-premature infants are at significant risk for IBI until 28 days adjusted age and UTI until 60 days adjusted age.
- Current diagnostic approaches may be insufficient for ruling out infections in this population.
- Further research is needed to establish optimal fever management strategies for ex-premature infants.
Background And Objectives:
To determine the rate of serious-bacterial-infections (SBI) in young ex-premature infants with fever, and to develop a risk-stratification algorithm for these patients.
Methods:
A retrospective cohort study including all infants who presented to the pediatric emergency department (ED) of a tertiary-care university-hospital between 2010 and 2020 with fever (≥38°C), were born prematurely (<37-weeks), had post-conception age of <52-weeks, and had available blood, urine, or CSF cultures. The rates of SBI by age-of-birth and age-at-visit were calculated and compared to a cohort of matched full-term controls.
Results:
The study included a total of 290 ex-premature cases and 290 full-term controls. There were 11 cases (3.8%) with an invasive bacterial infection (IBI) of either bacteremia, meningitis or both and only six controls (2.1%) with IBI (p = 0.32). Over 28-days chronologic-age, there were 10 (3.6%) IBIs among cases and no IBIs among the controls (p = 0.02). There were eight (3%) cases and three (1%) controls with IBI who were well-appearing on physical examination (p = 0.19). All eight well-appearing ex-premature infants were under 60-days adjusted-age, seven of whom (88%) were also under 28-days adjusted-age. There were 28 (10.6%) cases and 34 (12%) controls with urinary tract infection (UTI) (p = 0.5). Among cases under 60-days adjusted-age, urinalysis was not reliable to exclude UTI (50% negative).
Conclusions:
Well-appearing ex-preterm infants have a significant risk for IBI until the adjusted age of 28-days and for UTI until the adjusted age of 60-days. Further studies are needed to evaluate the approach to fever in this unique population.
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