Accuracy of a sequential approach to identify young febrile infants at low risk for invasive bacterial infection

Abstract

AbstractsResults Of the 1123 infants (Invasive Bacterial Infection -IBI-, 48; 4.2%), 488 (43.4%) were classified as low risk criteria for IBI according to the "step by step" approach (vs 693-61.7%-with the Labscore and 458-40.7%-with the Rochester criteria). The prevalence of IBI in the low-risk criteria patients was 0.2% (95% CI 0-0.6%) using the "step by step" approach (vs 0.7%-95% CI 0.1-1.3% with the Labscore and 1.1%-95% CI 0.1-2%-with Rochester). Using the "step by step" approach, 1 patient with IBI was not correctly classified (2.0%, CI95% 0-6.12) vs 5 using the Labscore or Rochester (10.4%, CI95% 1.76-19.04%). Conclusions A sequential approach to young febrile infants including procalcitonin identifies better patients more suitable for outpatient management. Inhaled foreign bodies are very serious problem in the pediatric pulmonology since they increase the rate of morbidity and mortality. Aim of this study was analysis of endoscopic changes caused by vegetable foreign bodies (VFB) in correlation with their long -standing in the bronchial tree. ENDOSCOPIC ASPECTS OF INHALED VEGETABLE FOREIGN BODIES IN CHILDREN Material and MethodsIn ten years period (2002)(2003)(2004)(2005)(2006)(2007)(2008)(2009)(2010)(2011) inhaled foreign bodies were removed in 219 children (age 6 mths-14 yrs), 60.27%-male and 39.73%-female. Most of the children (57.50%) belong to the youngest group of age (1-2 yrs). The inhaled foreign bodies were from organic origin in 208 (94.97%). Of these, 203 (92.69%) were with vegetable origin. The most commonly found grains were peanuts (57.14%). Inhaled foreign bodies were single object in 123 (56.16%) while in 96 (43.80%) they were multiple. Results Endoscopically we found:Insignificant inflammation (some hours presence of VFB) in 48 (23.64%)Significant inflammation -vulnerable mucous membrane (VFB with presence more than 3 days) in 78 (38.42%) Severe inflammation -manifest inflammation (VFB more than 7 days presence) in 77 (37.93%). In this group of children we detected:-granulomatous formations 57 (82.60%)-decubital changes 28 (40.57%)-mucopurulent secretion 41 (59.42%). Conclusion Severity of the endoscopic changes was closely correlated with the quality of the foreign body (vegetable ones), the period of lodgement and the age of the patients. Timely broncoscopic extirpation of VFB decreases the percentage of complications and represents the most successful and only logically carried out therapeutically procedure.

Validation of the “Step-by-Step” Approach in the Management of Young Febrile Infants

“…This finding, not observed in our previous retrospective study, 11 suggests to be cautious when assessing patients in the fourth week of age and recommends further studies to safely identify the best secondary age cutoff point.…”

“…This approach ( Fig 1) evaluates sequentially the general appearance of the infant, the age, and result of the urinalysis and, lastly, the results of blood biomarkers, including PCT, CRP, and absolute neutrophil count (ANC). We retrospectively tested the Step-by-Step approach in 1123 infants 11 and found that it is able to accurately identify different groups of patients according to their risk of suffering from a noninvasive or invasive bacterial infection (IBI). In addition, this approach seemed to better identify low risk patients suitable for an outpatient management compared with the Rochester criteria or the more recently developed Lab-score.…”

Facing the Ongoing Challenge of the Febrile Young Infant

“…Highlighting UTI as the most common bacterial infection in young febrile infants, this approach recommends evaluating age, clinical appearance and urinalysis results prior to obtaining blood samples [34]. This stepby-step approach has been prospectively validated and has a high sensitivity (92%) and NPV (99.3%) [35].…”

“…While an abnormal white blood cell (WBC) count in a febrile young infant is associated with serious bacterial infection, it is not a specific marker for serious bacterial infection (positive predictive value of 30-43.8% for WBC < 5,000 or > 15,000/mm 3 ) [12]. Compared to an abnormal WBC, elevated C-reactive protein (CRP) and procalcitonin (PCT) values are associated with serious bacterial infection with a greater sensitivity and specificity, with PCT being more sensitive than CRP for diagnosis of invasive bacterial infection [34,36]. CRP can often be elevated in viral infections and does not rise as acutely as PCT levels do, which can cause both false positive and negative results, respectively.…”

Outpatient management of selected young febrile infants without antibiotics

“…Most of them are brought to the emergency department (ED) very early,5 the main bacterial pathogens involved in invasive infections have changed16 17 and new blood tests are available to help detect patients with SBI 18. Different approaches for these patients including C reactive protein (CRP) and procalcitonin (PCT) have been developed 19 20. A sequential approach to these children, including both these biomarkers, has been shown to be highly sensitive in identifying those patients who are suitable for management as outpatients, including those coming to the ED early in the course of their disease 20.…”