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Fever in the first six months of life: risks of underlying serious infection
Insights
Fever over 38.3 C in infants under 3 months significantly increases the risk of serious infection. A selective diagnostic approach is crucial for febrile infants, prioritizing clinical evaluation.
Area of Science:
- Pediatrics
- Infectious Disease Epidemiology
Background:
- Fever is a common concern in infants, necessitating understanding of age-specific risks.
- Differentiating benign temperature elevations from signs of serious infection is critical for appropriate clinical management.
Purpose of the Study:
- To evaluate the age-specific incidence of elevated temperature in infants under six months.
- To determine the association between fever thresholds and specific infections in infants.
- To inform diagnostic strategies for febrile infants.
Main Methods:
- Retrospective analysis of infant visits (n=1341) over a four-year period (1974-1978).
- Categorization of temperature elevations (mild: 37.8 C-38.3 C; high: >38.3 C).
- Statistical analysis of infection rates and laboratory usage based on age and temperature.
Main Results:
- Mild temperature elevations were common (20.7% of visits).
- Temperatures >38.3 C were infrequent in early infancy but increased with age.
- Fever >38.3 C correlated with higher rates of meningitis, otitis media, and lower respiratory infections.
- Infants <3 months with fever >38.3 C had a 21.5 times higher risk of serious infection.
Conclusions:
- Selective diagnostic strategies are essential for febrile infants, especially those under three months.
- Clinical evaluation remains paramount in guiding laboratory and diagnostic testing decisions.
- Age and fever severity are key factors in assessing the risk of serious underlying infection.
Abstract:
The age-specific rate of elevated temperature over 37.8 C was evaluated in all infants less than 6 months of age (n = 1341) seen from July 1, 1974 to June 30, 1978 in a family practice clinic. Mild elevations (37.8 C-38.3 C) were common even in the first few months of life, and accounted for 20.7 per cent of infant visits. Temperatures greater than 38.3 C are uncommon in the first months of life but are seen more frequently with each succeeding month. Temperature elevation over 38.3 C was associated with a significantly higher rate of meningitis (p less than .01), otitis media (p less than .001) and lower respiratory infection (p less than .05). Significantly higher laboratory usage was documented in infants less than 3 months and for infants with temperature more than 38.3 C. The high rate of mild temperature elevations in young infants suggests that a selective diagnostic strategy directed at high-risk infants is important. Infants less than three months of age with a fever exceeding 38.3 C are calculated to have 21.5 times the risk of a serious underlying infection as infants older than three months with a similar temperature elevation. Clinical evaluation must remain an important tool in determining which febrile infants should be evaluated by further laboratory and diagnostic tests.