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The Critical Lens: It is time to start using the right test for febrile young infants
Adiel Marom1, Jesse Papenburg1,2, Brett Burstein2,3
1Division of Pediatric Infectious Diseases, Montreal Children's Hospital, McGill University Health Centre, Montreal, Quebec, Canada.
Insights
Fever in infants requires careful assessment to distinguish viral from bacterial infections. Procalcitonin testing aids management, but rapid availability is crucial for timely, evidence-based care and reducing unnecessary interventions.
Area of Science:
- Pediatrics
- Infectious Diseases
- Clinical Diagnostics
Background:
- Fever in young infants presents a diagnostic challenge, necessitating differentiation between common viral illnesses and serious bacterial infections like bacteremia and meningitis.
- Current clinical practice involves balancing the risks of underdiagnosis against the harms of over-investigation and overtreatment in febrile infants.
Purpose of the Study:
- To highlight the importance of procalcitonin testing in managing febrile infants.
- To advocate for improved accessibility and faster turnaround times for procalcitonin assays in clinical settings.
Main Methods:
- The abstract discusses the role of procalcitonin as a diagnostic biomarker.
- It references the Canadian Paediatric Society's position statement recommending procalcitonin-based risk stratification for febrile infants.
Main Results:
- Procalcitonin testing is identified as the optimal available diagnostic tool for guiding management decisions in febrile infants.
- Challenges with procalcitonin availability and turnaround time hinder its optimal use in many clinical environments.
Conclusions:
- Rapid access to procalcitonin results is essential for providing guideline-adherent care to febrile infants.
- Wider availability of procalcitonin testing can decrease unnecessary invasive procedures, hospitalizations, antibiotic use, and healthcare resource utilization.
Abstract:
Fever among infants in the first months of life is a common clinical conundrum facing all clinicians who treat children. Most well-appearing febrile young infants have viral illnesses. However, it is critical to identify those at risk of invasive bacterial infections, specifically bacteremia and bacterial meningitis. Clinicians must balance the risks of missing these infections against the harms of over-investigation. Procalcitonin testing is currently the best diagnostic test available to help guide management, and the Canadian Paediatric Society Position Statement on the management of febrile young infants recommends procalcitonin-based risk stratification. However, in many clinical settings, procalcitonin is either unavailable or has a turnaround time that is too long to aid decision-making. Clinicians who care for febrile young infants must have rapid access to procalcitonin results to provide best-evidence, guideline-adherent care. The wider availability of this test is essential to reduce unnecessary invasive testing, hospitalizations, and antibiotic exposure and could reduce system-wide resource utilization.
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