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Paediatric emergency departments should manage young febrile and afebrile infants the same if they have a fever before presenting

Orfanos, Ioannis LU orcid ; Sotoca Fernandez, Jorge LU ; Elfving, Kristina LU ; Alfvén, Tobias LU and Eklund, Erik A LU (2022) In Acta Pædiatrica 111(10). p.2004-2009
Abstract

AIM: Our aim was to evaluate the risk of bacterial meningitis, bacteremia, and urinary tract infection (UTI) in infants ≤60 days who presented to pediatric emergency departments (PEDs) after having fever at home. We also investigated any differences between infants who were afebrile or febrile on presentation.

METHODS: Multicenter retrospective study of infants ≤60 days presented to 4 Swedish PEDs during 2014-2020 with reported fever at home. We used relative risks (RR) to compare the prevalence of UTI, bacteremia, and bacterial meningitis between the infants who were afebrile and the infants who were still febrile when they presented to the PED.

RESULTS: The cohort comprised 1926 infants and 702 (36%) were afebrile on... (More)

AIM: Our aim was to evaluate the risk of bacterial meningitis, bacteremia, and urinary tract infection (UTI) in infants ≤60 days who presented to pediatric emergency departments (PEDs) after having fever at home. We also investigated any differences between infants who were afebrile or febrile on presentation.

METHODS: Multicenter retrospective study of infants ≤60 days presented to 4 Swedish PEDs during 2014-2020 with reported fever at home. We used relative risks (RR) to compare the prevalence of UTI, bacteremia, and bacterial meningitis between the infants who were afebrile and the infants who were still febrile when they presented to the PED.

RESULTS: The cohort comprised 1926 infants and 702 (36%) were afebrile on presentation. The prevalence of UTI in the afebrile and febrile infants were 6.1% (95% CI 4.5-8.2) versus 14.2% (95% CI 12.3-16.2), corresponding to an RR of 0.43 (95% CI 0.31-0.59). In infants ≤28 days the RR for meningitis was 1.05 (95% CI 0.18-6.23) for afebrile versus febrile infants. Five times more febrile infants underwent a lumbar puncture.

CONCLUSION: Infants who were afebrile on presentation underwent fewer lumbar punctures, but they had similar rates of bacterial meningitis to febrile infants. Different management approaches are not justified.

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author
; ; ; and
organization
publishing date
type
Contribution to journal
publication status
published
subject
in
Acta Pædiatrica
volume
111
issue
10
pages
2004 - 2009
publisher
Wiley-Blackwell
external identifiers
  • pmid:35808896
  • scopus:85134219629
ISSN
1651-2227
DOI
10.1111/apa.16483
project
Prevalence of serious bacterial infections and management of febrile infants ≤60 days in Swedish Pediatric Emergency Departments
language
English
LU publication?
yes
additional info
This article is protected by copyright. All rights reserved.
id
b9ba0c52-7c0a-4ea8-b9ea-427e476d81e5
date added to LUP
2022-07-16 16:47:42
date last changed
2024-06-28 22:02:51
@article{b9ba0c52-7c0a-4ea8-b9ea-427e476d81e5,
  abstract     = {{<p>AIM: Our aim was to evaluate the risk of bacterial meningitis, bacteremia, and urinary tract infection (UTI) in infants ≤60 days who presented to pediatric emergency departments (PEDs) after having fever at home. We also investigated any differences between infants who were afebrile or febrile on presentation.</p><p>METHODS: Multicenter retrospective study of infants ≤60 days presented to 4 Swedish PEDs during 2014-2020 with reported fever at home. We used relative risks (RR) to compare the prevalence of UTI, bacteremia, and bacterial meningitis between the infants who were afebrile and the infants who were still febrile when they presented to the PED.</p><p>RESULTS: The cohort comprised 1926 infants and 702 (36%) were afebrile on presentation. The prevalence of UTI in the afebrile and febrile infants were 6.1% (95% CI 4.5-8.2) versus 14.2% (95% CI 12.3-16.2), corresponding to an RR of 0.43 (95% CI 0.31-0.59). In infants ≤28 days the RR for meningitis was 1.05 (95% CI 0.18-6.23) for afebrile versus febrile infants. Five times more febrile infants underwent a lumbar puncture.</p><p>CONCLUSION: Infants who were afebrile on presentation underwent fewer lumbar punctures, but they had similar rates of bacterial meningitis to febrile infants. Different management approaches are not justified.</p>}},
  author       = {{Orfanos, Ioannis and Sotoca Fernandez, Jorge and Elfving, Kristina and Alfvén, Tobias and Eklund, Erik A}},
  issn         = {{1651-2227}},
  language     = {{eng}},
  month        = {{07}},
  number       = {{10}},
  pages        = {{2004--2009}},
  publisher    = {{Wiley-Blackwell}},
  series       = {{Acta Pædiatrica}},
  title        = {{Paediatric emergency departments should manage young febrile and afebrile infants the same if they have a fever before presenting}},
  url          = {{http://dx.doi.org/10.1111/apa.16483}},
  doi          = {{10.1111/apa.16483}},
  volume       = {{111}},
  year         = {{2022}},
}