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FeBRILe3: Risk-Stratification and Diagnosis of Serious Bacterial Infections in Febrile Infants Less Than 3 Months Old

Ariel O Mace1,2,3, Jessica Ramsay3, James Totterdell4

  • 1Department of General Paediatrics, Perth Children's Hospital, Perth, Western Australia, Australia.

Journal of Paediatrics and Child Health
|March 28, 2025
PubMed

Insights

A new guideline for fever without source (FWS) in infants showed high sensitivity for serious bacterial infections (SBIs) but low specificity. Further refinement is needed to improve prediction tools for infant fever management.

Area of Science:

  • Pediatric Infectious Diseases
  • Clinical Epidemiology
  • Risk Stratification

Background:

  • Existing evidence-based recommendations support early discharge for low-risk infants with fever without source (FWS).
  • Local context applicability of international data for FWS management remains a concern.
  • A new risk-stratification guideline was implemented to address local needs.

Purpose of the Study:

  • To describe the local epidemiology of FWS in young infants.
  • To evaluate the performance of a newly implemented risk-stratification guideline for FWS.
  • To support practice change in managing infants with FWS.

Main Methods:

  • Prospective observational study of infants under 3 months with FWS.
  • Two hospitals in Perth, Western Australia, participated from August 2019 to December 2021.
  • Assessed guideline performance and determined likelihood ratios for patient characteristics predicting serious bacterial infections (SBIs).

Main Results:

  • The cohort included 500 infants; 32% were diagnosed with SBIs (UTI, bacteremia, meningitis).
  • The risk-stratification guideline showed 99% sensitivity and 97% negative predictive value for SBIs.
  • Specificity was low (21%); female sex, sick contact, and virus detection reduced SBI likelihood.

Conclusions:

  • The guideline effectively excluded most infants without SBIs but had limited predictive value for identifying low-risk infants.
  • Additional patient characteristics are needed to enhance the accuracy of future risk-prediction tools.
  • Refined algorithms can improve the management of fever without source in infants.
Abstract

Keywords:
infant feverrisk‐stratificationserious bacterial infection

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