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Published on: August 12, 2020
A Population-Based Study of Rates of Invasive Bacterial Infection (IBI) and Missed IBI in Febrile Infants 8-90 Days
Jeffrey P Yaeger1, Elaine L Hill2, Ashkan Ertefaie3
1Department of Pediatrics, University of Rochester School of Medicine and Dentistry, Rochester, NY; Department of Public Health Sciences, University of Rochester Medical Center, Rochester, NY.
Insights
Invasive bacterial infection (IBI) rates decrease with age in febrile infants, but diagnostic testing and hospitalization also decline, increasing missed diagnoses. Targeted strategies are needed for high-risk infants.
Area of Science:
- Pediatrics
- Infectious Diseases
- Public Health
Background:
- Febrile young infants require prompt evaluation for invasive bacterial infections (IBIs), including bacteremia and bacterial meningitis.
- Understanding population-based IBI rates and diagnostic trends is crucial for optimizing care.
Purpose of the Study:
- To determine population-based rates of IBI in febrile infants aged 8-90 days.
- To compare demographic characteristics of infants with IBIs to the general infant population.
- To assess trends in lumbar puncture performance, hospitalization, and missed IBI diagnoses.
Main Methods:
- Utilized New York State's all-payer database (2012-2023) to identify healthy, full-term infants (8-90 days) evaluated for fever.
- Employed chi-square statistics to compare IBI rates and demographics.
- Calculated age-stratified performance of lumbar puncture, hospitalization, and missed IBI proportions.
Main Results:
- The overall IBI rate was 5.3 per 1,000,000 infant-days, decreasing significantly with age (P < .0001).
- Infants with IBIs showed significant demographic differences (sex, insurance, race, ethnicity, hospital type; P < .00001).
- Lumbar puncture and hospitalization rates decreased with age, while missed IBI proportions increased (P < .05). IBI rates remained stable over 12 years.
Conclusions:
- IBI rates, lumbar puncture, and hospitalization decline with infant age, alongside an increase in missed diagnoses.
- Significant demographic disparities exist among febrile infants with IBIs.
- Strategies to reduce IBIs and missed diagnoses in vulnerable infant populations are warranted.
Objectives:
To establish population-based rates of invasive bacterial infection (IBI; bacteremia and/or bacterial meningitis) in febrile young infants, to compare demographic characteristics of febrile infants with IBIs with liveborn infants, to calculate performance of lumbar puncture and hospitalization proportions, and to estimate the proportion of missed IBI diagnoses.
Study Design:
We used New York State's all-payer database to identify healthy, full-term, febrile infants aged 8 to 90 days of age who were evaluated for fever in emergency departments from 2012 to 2023. Using chi square statistics, we compared IBI rates and demographic characteristics of febrile infants with IBIs with the age-stratified population. We calculated age-stratified performance of lumbar puncture, hospitalization, and missed IBI proportions.
Results:
Of the 2 295 788 healthy, full-term births, 66 692 infants were evaluated in emergency departments between 8 and 90 days of age with fever. The IBI rate was 5.3 of 1 000 000 infant-days and decreased significantly with advancing age to 90 days (P < .0001). Febrile infants with IBIs differed significantly by sex, type of insurance, race, ethnicity, and type of hospital emergency department (P < .00001). Lumbar puncture and hospitalization proportions decreased significantly (P < .0001) with advancing age whereas missed IBI proportions increased (P < .05). IBI rates did not change over the 12-year study period.
Conclusions:
Findings demonstrate a stepwise reduction in rates of IBIs and performance of lumbar puncture and hospitalization with advancing age to 90 days, coupled with an increase in proportions of missed IBIs. Significant demographic differences exist between febrile infants with IBIs and the population of age-matched infants. Strategies to reduce IBIs and missed IBIs in high-risk groups should be pursued.
