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Prevalence of Invasive Bacterial Infection in Hypothermic Young Infants: A Multisite Study
Jennifer L Raffaele1, Meenu Sharma2, Stephanie Berger2
1Department of Pediatrics, University of South Carolina School of Medicine Greenville, Prisma Health Children's Hospital-Upstate, Greenville, NC.
Insights
The prevalence of invasive bacterial infection (IBI) in hypothermic infants under 90 days is 2.1%. Key indicators for IBI include temperature instability, abnormal white blood cell counts, and thrombocytopenia.
Area of Science:
- Pediatrics
- Infectious Diseases
- Neonatology
Background:
- Hypothermia is a critical condition in young infants, potentially indicating serious infections.
- Invasive bacterial infections (IBI) pose a significant risk to neonates and infants.
Purpose of the Study:
- To determine the prevalence of invasive bacterial infections (IBI) in hypothermic young infants.
- To identify characteristics associated with IBI in this vulnerable population.
Main Methods:
- A retrospective cohort study was conducted on 1098 infants ≤90 days with hypothermia.
- Data were collected from September 2017 to May 2021, excluding infants with hypothermia during birth hospitalization or fever.
- Multivariable mixed-effects logistic regression was used to identify associations with IBI.
Main Results:
- The prevalence of IBI was 2.1% (bacteremia 1.8%, bacterial meningitis 0.5%).
- Serious bacterial infection (SBI) prevalence was 4.4%, and neonatal herpes simplex virus prevalence was 1.3%.
- Significant associations with IBI included repeated temperature instability, abnormal white blood cell counts, and thrombocytopenia.
Conclusions:
- Invasive bacterial infection (IBI) occurs in 2.1% of hypothermic young infants.
- Identifying associated characteristics can aid in developing management decision tools for these infants.
Objective:
To determine the prevalence of bacteremia and meningitis (invasive bacterial infection [IBI]) in hypothermic young infants, and also to determine the prevalence of serious bacterial infections (SBI) and neonatal herpes simplex virus and to identify characteristics associated with IBI.
Study Design:
We conducted a retrospective cohort study of infants ≤90 days of age who presented to 1 of 9 hospitals with historical or documented hypothermia (temperature ≤36.0°C) from September 1, 2017, to May 5, 2021. Infants were identified by billing codes or electronic medical record search of hypothermic temperatures. All charts were manually reviewed. Infants with hypothermia during birth hospitalization, and febrile infants were excluded. IBI was defined as positive blood culture and/or cerebrospinal fluid culture treated as a pathogenic organism, whereas SBI also included urinary tract infection. We used multivariable mixed-effects logistic regression to identify associations between exposure variables and IBI.
Results:
Overall, 1098 young infants met the inclusion criteria. IBI prevalence was 2.1% (95% CI, 1.3-2.9) (bacteremia 1.8%; bacterial meningitis 0.5%). SBI prevalence was 4.4% (95% CI, 3.2-5.6), and neonatal herpes simplex virus prevalence was 1.3% (95% CI, 0.6-1.9). Significant associations were found between IBI and repeated temperature instability (OR, 4.9; 95% CI, 1.3-18.1), white blood cell count abnormalities (OR, 4.8; 95% CI, 1.8-13.1), and thrombocytopenia (OR, 5.0; 95% CI, 1.4-17.0).
Conclusions:
IBI prevalence in hypothermic young infants is 2.1%. Further understanding of characteristics associated with IBI can guide the development decision tools for management of hypothermic young infants.
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