A week-by-week analysis of the low-risk criteria for serious bacterial infection in febrile neonates

Schwartz, Shepard; Raveh, David; Toker, Ori; Segal, Gershon; Godovitch, Nadia; Schlesinger, Yechiel

doi:10.1136/adc.2008.138768

Cited by 73 publications

(56 citation statements)

References 31 publications

(41 reference statements)

Supporting

Mentioning

Contrasting

Unclassified

Order By: Relevance

“…This is higher in infants aged 0-28 days (9-28%) than those 2-3 months old (7.1%) [2][3][4][5][6][7][8][9]15,16]. We found the overall rate of SBI was high (38.4%) and our findings confirmed that SBI was seen more frequent in the neonatal period.…”

Section: Discussionsupporting

confidence: 80%

“…On the other hand, UTI was found higher and reported that 14-21.3 percent in febrile neonatesthat means UTI affects approximately 1 in 6 febrile neonates [2][3][4][5][6][7][8][9][10][11]18]. In our study, UTI incidence was found similarly the most common etiology of fever in neonatal period.…”

Section: Discussionsupporting

confidence: 48%

“…Although such fevers are typically self-limiting, it has been reported that 7.1-19.7% of affected neonate also have serious bacterial infection (SBI) [2][3][4][5]. Febrileinfants younger than ≤ 28 days are at higher risk of serious bacterial infections (SBI), traditionally, so they need to go through laboratory investigation and hospitalization due to increased susceptibilityto infections.…”

Section: Introductionmentioning

confidence: 99%

“…Therefore large numbers of febrile neonates continue to receive unnecessary treatment that generates emotional stress to parents, costsand may be associated with iatrogenic complications and antibiotic resistance [2][3][4][5][6]. Rochester and Philadelphia protocols can be used for identification of Serious bacterial infections in older infants, but in neonatal period sensitivity of these protocols are low [7].…”

Section: Introductionmentioning

confidence: 99%

See 3 more Smart Citations

Etiology and Causative Pathogens of Febrile Neonates

Bülbül¹,

Bülbül²,

Ocak³

et al. 2018

Pediatric Infect Dis

View full text Add to dashboard Cite

Background: Evaluation and treatment of febrile neonates varied widely among the different centers. The prevalence of serious bacterial infection (SBI) is high in neonates; thus, most experts would support the approach of a full sepsis evaluation and hospitalization. We aimed to evaluate the clinical and laboratory characteristics of febrile neonate less than 28 days of age and describe the incidence of SBI in febrile neonates.

show abstract

Section: Discussionsupporting

confidence: 80%

Section: Discussionsupporting

confidence: 48%

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

See 2 more Smart Citations

Etiology and Causative Pathogens of Febrile Neonates

Bülbül¹,

Bülbül²,

Ocak³

et al. 2018

Pediatric Infect Dis

View full text Add to dashboard Cite

show abstract

“…[7][8][9] A recent study of febrile neonates concluded that lowrisk criteria are not sufficiently reliable to exclude the presence of SIs in febrile neonates in any age category under 28 days. 10 They recommend that all febrile neonates #28 days of age should therefore be hospitalized, undergo a full sepsis evaluation, and receive empirical intravenous antibiotic therapy. Garcia et al 11 evaluated whether 15 days was an appropriate cutoff for considering SI in the management of febrile neonates and concluded that febrile neonates 15 to 21 days of age had a rate of serious bacterial infection similar to that of younger infants and higher than that of older infants.…”

mentioning

confidence: 99%

Management of Febrile Neonates in US Pediatric Emergency Departments

et al. 2014

View full text Add to dashboard Cite

WHAT'S KNOWN ON THIS SUBJECT: Recommended management of febrile neonates (#28 days) includes blood, urine, and cerebrospinal fluid cultures with hospital admission for antibiotic therapy. No study has reported adherence to standard recommendations in the management of febrile neonates in US pediatric emergency departments. WHAT THIS STUDY ADDS:There is wide variation in adherence to recommended management of febrile neonates. High rates of serious infections in admitted patients but low return rates for missed infections in discharged patients suggest additional studies needed to understand variation from current recommendations. abstract BACKGROUND: Blood, urine, and cerebrospinal fluid cultures and admission for antibiotics are considered standard management of febrile neonates (0-28 days). We examined variation in adherence to these recommendations across US pediatric emergency departments (PEDs) and incidence of serious infections (SIs) in febrile neonates. METHODS:Cross-sectional study of neonates with a diagnosis of fever evaluated in 36 PEDs in the 2010 Pediatric Health Information System database. We analyzed performance of recommended management (laboratory testing, antibiotic use, admission to hospital), 48-hour return visits to PED, and diagnoses of SI. RESULTS:Of 2253 neonates meeting study criteria, 369 (16.4%) were evaluated and discharged from the PED; 1884 (83.6%) were admitted. Recommended management occurred in 1497 of 2253 (66.4%; 95% confidence interval, 64.5-68.4) febrile neonates. There was more than twofold variation across the 36 PEDs in adherence to recommended management, recommended testing, and recommended treatment of febrile neonates. There was significant variation in testing and treatment between admitted and discharged neonates (P , .001). A total of 269 in 2253 (11.9%) neonates had SI, of whom 223 (82.9%; 95% confidence interval, 77.9-86.9) received recommended management.CONCLUSIONS: There was wide variation across US PEDs in adherence to recommended management of febrile neonates. One in 6 febrile neonates was discharged from the PED; discharged patients were less likely to receive testing or antibiotic therapy than admitted patients. A majority of neonates with SI received recommended evaluation and management. High rates of SI in admitted patients but low return rates for missed infections in discharged patients suggest a need for additional studies to understand variation from the current recommendations.

show abstract