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Updated: Jun 23, 2025
A Neonatal Imaging Model of Gram-Negative Bacterial Sepsis
Published on: August 12, 2020
Delayed presentation is associated with serious bacterial infections among febrile infants: A prospective cohort
Karthigha Pon Rajoo1, Natalia Sutiman1, Stephanie Shih2
1Department of Children's Emergency, KK Women's and Children's Hospital, Singapore.
Insights
Delayed presentation in febrile infants increases the risk of serious bacterial infections (SBIs). Early medical attention for infant fever is crucial to prevent severe outcomes and ensure timely treatment.
Area of Science:
- Pediatrics
- Infectious Diseases
- Emergency Medicine
Background:
- Febrile young infants face a significant risk of serious bacterial infections (SBIs).
- Timely diagnosis and treatment are critical for managing SBIs in this vulnerable population.
Purpose of the Study:
- To investigate the association between delayed presentation and the risk of SBIs in febrile infants.
- To analyze clinical outcomes related to delayed presentation in febrile infants.
Main Methods:
- Prospective cohort study of febrile infants ≤90 days old.
- Definition of delayed presentation: >24 hours from fever onset.
- Multivariable logistic regression analysis to assess independent association.
Main Results:
- Delayed presentation occurred in 10% of 1911 infants.
- SBIs were more common in infants with delayed presentation (28.8% vs. 16.3%).
- Delayed presentation was independently associated with a higher risk of SBI (AOR 1.78).
Conclusions:
- Febrile infants presenting late are at increased risk for serious bacterial infections.
- Frontline clinicians must consider delayed presentation as a risk factor for SBIs in febrile infants.
Introduction:
Febrile young infants are at risk of serious bacterial infections (SBIs), which are potentially life-threatening. This study aims to investigate the association between delayed presentation and the risk of SBIs among febrile infants.
Method:
We performed a prospective cohort study on febrile infants ≤90 days old presenting to a Singapore paediatric emergency department (ED) between November 2017 and July 2022. We defined delayed presentation as presentation to the ED >24 hours from fever onset. We compared the proportion of SBIs in infants who had delayed presentation compared to those without, and their clinical outcomes. We also performed a multivariable logistic regression to study if delayed presentation was independently associated with the presence of SBIs.
Results:
Among 1911 febrile infants analysed, 198 infants (10%) had delayed presentation. Febrile infants with delayed presentation were more likely to have SBIs (28.8% versus [vs] 16.3%, P<0.001). A higher proportion of infants with delayed presentation required intravenous antibiotics (64.1% vs 51.9%, P=0.001). After adjusting for age, sex and severity index score, delayed presentation was independently associated with the presence of SBI (adjusted odds ratio [AOR] 1.78, 95% confidence interval 1.26-2.52, P<0.001).
Conclusion:
Febrile infants with delayed presentation are at higher risk of SBI. Frontline clinicians should take this into account when assessing febrile infants.
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