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Risk of infection during adrenocorticotropic hormone treatment in infants with infantile spasms
Insights
Febrile episodes in infants with infantile spasms treated with adrenocorticotropic hormone (ACTH) or prednisone carry a risk of bacteremia. Higher ACTH doses may increase mortality risk during these infections.
Area of Science:
- Pediatrics
- Infectious Diseases
- Neonatology
Background:
- Infantile spasms are a serious neurological condition in infants.
- Febrile episodes in infants receiving adrenocorticotropic hormone (ACTH) or prednisone require careful evaluation for serious infections.
- Assessing the risk of bacteremia and identifying infections early is crucial.
Purpose of the Study:
- To evaluate the incidence of bacteremia during febrile episodes in infants with infantile spasms treated with ACTH or prednisone.
- To determine the risk of serious infection and identify predictors of bacteremia.
- To assess the outcome of febrile episodes and the impact of medication dosage.
Main Methods:
- Retrospective review of clinical features and laboratory findings in 27 infants with infantile spasms.
- Analysis of 75 febrile episodes, including incidence of bacteremia and causative pathogens.
- Evaluation of diagnostic utility of chest radiography and laboratory markers like leukocytosis.
Main Results:
- Four episodes (5.3%) of bacteremia were identified among 75 febrile episodes.
- Leukocytosis and a high proportion of immature granulocytes were predictive of bacteremia.
- Chest radiography aided in identifying fever sources; isolated pathogens were typical for the age group.
Conclusions:
- The incidence of bacteremia in this population is comparable to age-matched infants.
- Febrile episodes in infants with infantile spasms treated with ACTH/prednisone have a frequently fatal outcome.
- Higher than recommended ACTH dosages may be associated with increased mortality during febrile episodes.
Abstract:
We reviewed the clinical features and laboratory findings of 27 infants with infantile spasms treated with adrenocorticotropic hormone or prednisone during febrile episodes in order to evaluate the incidence of bacteremia, the risk of serious infection, determination of whether serious infections can be identified at presentation and the outcome of febrile episodes. There were 75 febrile episodes including 4 episodes of identified bacteremia (5.3%). Three children who were treated with adrenocorticotropic hormone dosage larger than recommended died. Leukocytosis and a differential count with many immature granulocytes predicted bacteremia in this population. Chest radiography was useful in identifying the cause of fever. The pathogens isolated were similar to those found in this age range. We conclude that the frequency of bacteremia in our patient population is similar to that observed in infants of the same age; however, the outcome is frequently fatal. In addition this increased mortality may be associated with the use of a larger dosage of adrenocorticotropic hormone than recommended.