Related Experiment Videos
Reliability of observation variables in distinguishing infectious outcome of febrile young infants
W A Bonadio1, H Hennes, D Smith
1Medical College of Wisconsin, Children's Hospital of Wisconsin, Milwaukee.
Insights
A new Young Infant Observation Scale effectively distinguishes serious bacterial infections (SBI) in febrile infants. This scale, using affect, respiratory status, and perfusion, aids in early diagnosis of infant infections.
Area of Science:
- Pediatrics
- Infectious Diseases
- Clinical Assessment
Background:
- Febrile infants under 8 weeks require accurate assessment to differentiate serious bacterial infections (SBI) from less severe conditions.
- Clinical observation variables are crucial for evaluating infant well-being but their reliability in predicting infectious outcomes needs further validation.
Purpose of the Study:
- To prospectively evaluate 7 clinical observation variables for their reliability in distinguishing infectious outcomes in febrile infants aged 0-8 weeks.
- To develop and validate a reliable scale for assessing the risk of serious bacterial infections in young infants.
Main Methods:
- Prospective evaluation of 233 febrile infants (0-8 weeks) using 7 clinical variables (activity, alertness, respiration, perfusion, tone, affect, feeding).
- Variables were scored 1, 3, or 5, with higher scores indicating greater compromise. Infants underwent physical examination and sepsis evaluation.
- Stepwise discriminant analysis identified key variables for the Young Infant Observation Scale (YIOS).
Main Results:
- The mean score for all 7 variables was significantly higher in the serious bacterial infection (+SBI) group compared to aseptic meningitis (AM) and culture-negative/normal CSF (CN-NCSF) groups (P < 0.05).
- Affect, respiratory status/effort, and peripheral perfusion were identified as the most distinguishing variables, forming the Young Infant Observation Scale (YIOS).
- A YIOS score >= 7 demonstrated 76% sensitivity, 75% specificity, and 96% negative-predictive value for +SBI.
Conclusions:
- The Young Infant Observation Scale (YIOS), utilizing affect, respiratory status/effort, and peripheral perfusion, reliably distinguishes serious bacterial infections in febrile infants.
- The YIOS provides a valuable, objective tool for clinicians assessing febrile infants, aiding in the early identification of serious infections.
- The scale's high negative-predictive value suggests it can help rule out serious bacterial infections in infants presenting with fever.
Abstract:
We prospectively evaluated 7 observation variables (level of activity, level of alertness, respiratory status/effort, peripheral perfusion, muscle tone, affect, feeding pattern) which qualify patient clinical appearance in order to determine reliability in distinguishing the infectious outcome of 233 febrile infants ages 0 to 8 weeks. Each variable was graded either 1, 3, or 5, with a higher score indicative of a greater degree of compromise. All infants received physical examination and sepsis evaluation (lumbar puncture, complete blood count/blood culture, urinalysis/urine culture). The 3 outcome groups compared were 29 cases of serious bacterial infections, (+SBI; 10 with bacterial meningitis, 12 with bacteremia, 7 with urinary tract infection), 45 cases of aseptic meningitis (AM) and 159 cases culture-negative with normal cerebrospinal fluid (CN-NCSF). The mean score for each of the 7 variables was significantly greater in the +SBI group compared with both the AM and CN-NCSF groups (P < 0.05), whereas there was no significant difference in mean score for each of the 7 variables between the AM and CN-NCSF groups. Stepwise discriminant analysis identified 3 variables that best distinguished outcome: affect; respiratory status/effort; and peripheral perfusion, which constituted the Young Infant Observation Scale. The mean total Young Infant Observation Scale score generated from assessing these 3 variables was significantly greater (P = 0.0001) in the +SBI, group (9) compared with both the AM (5) and CN-NCSF (5) groups. A total Young Infant Observation Scale score > or = 7 had a sensitivity of 76%, specificity of 75% and negative-predictive value of 96% for outcome of +SBI.