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Fever in infants less than 3 months of age
Insights
Febrile infants under 3 months require careful assessment for serious bacterial infection. Current criteria have limitations, suggesting a need for refined diagnostic approaches and further research.
Area of Science:
- Pediatrics
- Infectious Diseases
- Clinical Medicine
Background:
- Febrile episodes in young infants (<3 months) are common, necessitating accurate diagnosis of serious bacterial infections (SBIs).
- Existing clinical criteria aim to stratify risk but may have limitations in identifying all infants with SBIs.
Purpose of the Study:
- To evaluate the effectiveness of Dagan et al.'s 1985 criteria in identifying serious bacterial infections in febrile infants younger than 3 months.
- To assess the negative predictive value of these criteria and explore potential improvements for clinical application.
Main Methods:
- Retrospective analysis of 207 febrile episodes in infants <3 months old.
- Application of Dagan et al.'s criteria to categorize infants into high-risk and low-risk groups for SBI.
- Comparison of SBI incidence between risk groups and calculation of negative predictive value.
Main Results:
- Overall SBI incidence was 20.5%.
- High-risk infants had a significantly higher SBI rate (44.4%) compared to low-risk infants (9.2%).
- The negative predictive value of the criteria was 90.8%, deemed lower than optimal, indicating potential for missed SBIs.
Conclusions:
- The Dagan et al. criteria demonstrate utility in risk stratification but have limitations in excluding SBI in febrile infants.
- Consideration of additional low-risk factors, such as normal stool analysis, may improve predictive power.
- Further prospective studies are recommended to validate refined criteria before widespread clinical adoption.
Abstract:
A retrospective study of 207 febrile episodes by infants less than 3 months old was performed. Most infants had rectal temperatures ranging from 38 to 39.9 degrees C and only 6 (3%) infants had fever above 40 degrees C per rectum. One hundred and nine (53%) of 207 visits resulted in subsequent hospitalizations including most by infants under 1 month of age. Urinary tract infection was the most common bacterial infection and upper respiratory tract infection the most common viral infection observed. A total of 112 infants were assigned into high-risk or low-risk group for serious bacterial infection by the application of the criteria proposed by Dagan et al. in 1985. The overall incidence of serious bacterial infection was 20.5% (23 patients). Seven (9.2%) of the 76 infants in the low-risk group had serious bacterial infection, compared with 16 (44.4%) of the 36 in the high-risk group (p < 0.05). The negative predictive value of meeting the criteria was 90.8%, a value unacceptably lower than those of previous studies. For maximizing the negative predictive power of the criteria, the addition of another low-risk factor, a normal stool analysis, is suggested. Besides, urine cultures should be taken concomitantly with urinalyses in febrile infants, when considering nonpyuria in infants with urinary tract infections. We demonstrate the pitfalls and difficulties in the application of the criteria for excluding serious bacterial infection in febrile young infants and suggest prospective studies involving more patients should be undertaken before its wider application in clinical practice.