United States’ Emergency Department Visits for Fever by Young Children 2007-2017

Ramgopal, Sriram; Aronson, Paul L.; Marín, Jennifer R.

doi:10.5811/westjem.2020.8.47455

Cited by 14 publications

(6 citation statements)

References 30 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…Febrile infants younger than 90 days old form a significant proportion of patients seeking care in the emergency department (ED). A cross-sectional study estimated 2 million febrile infants ≤ 90 days old presenting to EDs in the USA over the recent decade (2007-2017) [1,2]. Among young febrile infants, up to 10-15% of have a serious bacterial infection (SBI) defined as bacteraemia, meningitis or urinary tract infection (UTI) [3][4][5].…”

Section: Introductionmentioning

confidence: 99%

Pyrexia in a young infant – is height of fever associated with serious bacterial infection?

Victoria

Yong-Kwang

et al. 2022

BMC Pediatr

View full text Add to dashboard Cite

Background Febrile infants ≤ 90 days old make up a significant proportion of patients seeking care in the emergency department (ED). These infants are vulnerable to serious bacterial infections (SBIs) and early identification is required to initiate timely investigations and interventions. We aimed to study if height of an infant’s temperature on presentation to the ED is associated with SBI. Methods We performed a retrospective chart review on febrile infants ≤ 90 days old presenting to our ED between 31st March 2015 and 28th February 2016. We compared triage temperature of febrile infants with and without SBIs. We presented sensitivity, specificity, positive and negative predictive values (PPV and NPV) of fever thresholds at triage. A multivariable regression was performed to study the association between height of temperature and the presence of SBI, and presented the adjusted odds ratio (aOR) with corresponding 95% confidence intervals (CI). Results Among 1057 febrile infants analysed, 207 (19.6%) had a SBI. Mean temperature of infants with a SBI was significantly higher than those without (mean 38.5 °C, standard deviation, SD 0.6 vs. 38.3 °C, SD 0.5, p < 0.005). For temperature ≥ 39 °C, sensitivity, specificity, PPV and NPV for SBI was 15.5% (95%CI 10.8—21.1%), 90.4% (95%CI 88.2—92.3%), 28.1% (95%CI 21.1—36.3%) and 81.4% (95%CI 80.5—82.4%) respectively. The height of fever was consistently associated with SBI after adjusting for age, gender and SIS (aOR 1.76, 95% CI 1.32—2.33, p < 0.001). However, 32 (15.5%) infants with SBIs had an initial triage temperature ≤ 38 °C. Conclusions A higher temperature at triage was associated with a higher risk of SBI among febrile infants ≤ 90 days old. However, height of temperature must be used in conjunction with other risk factors to identify SBIs in young infants.

show abstract

Section: Introductionmentioning

confidence: 99%

Pyrexia in a young infant – is height of fever associated with serious bacterial infection?

Victoria

Yong-Kwang

et al. 2022

BMC Pediatr

View full text Add to dashboard Cite

show abstract

“…Of the nearly 200 000 febrile infants aged 60 days or younger who are evaluated in US emergency departments (EDs) each year, 7% to 10% have a urinary tract infection (UTI), 2% to 3% have bacteremia, and 0.5% to 1% have bacterial meningitis, the latter 2 infections collectively termed invasive bacterial infection (IBI) . Most infants presenting with fever, however, have a viral infection, including many with upper respiratory tract infections such as respiratory syncytial virus, influenza, and rhinovirus .…”

Section: Introductionmentioning

confidence: 99%

Prevalence of Urinary Tract Infection, Bacteremia, and Meningitis Among Febrile Infants Aged 8 to 60 Days With SARS-CoV-2

et al. 2023

View full text Add to dashboard Cite

ImportanceThe prevalence of urinary tract infection (UTI), bacteremia, and bacterial meningitis in febrile infants with SARS-CoV-2 is largely unknown. Knowledge of the prevalence of these bacterial infections among febrile infants with SARS-CoV-2 can inform clinical decision-making.ObjectiveTo describe the prevalence of UTI, bacteremia, and bacterial meningitis among febrile infants aged 8 to 60 days with SARS-CoV-2 vs without SARS-CoV-2.Design, Setting, and ParticipantsThis multicenter cross-sectional study was conducted as part of a quality improvement initiative at 106 hospitals in the US and Canada. Participants included full-term, previously healthy, well-appearing infants aged 8 to 60 days without bronchiolitis and with a temperature of at least 38 °C who underwent SARS-CoV-2 testing in the emergency department or hospital between November 1, 2020, and October 31, 2022. Statistical analysis was performed from September 2022 to March 2023.ExposuresSARS-CoV-2 positivity and, for SARS-CoV-2–positive infants, the presence of normal vs abnormal inflammatory marker (IM) levels.Main Outcomes and MeasuresOutcomes were ascertained by medical record review and included the prevalence of UTI, bacteremia without meningitis, and bacterial meningitis. The proportion of infants who were SARS-CoV-2 positive vs negative was calculated for each infection type, and stratified by age group and normal vs abnormal IMs.ResultsAmong 14 402 febrile infants with SARS-CoV-2 testing, 8413 (58.4%) were aged 29 to 60 days; 8143 (56.5%) were male; and 3753 (26.1%) tested positive. Compared with infants who tested negative, a lower proportion of infants who tested positive for SARS-CoV-2 had UTI (0.8% [95% CI, 0.5%-1.1%]) vs 7.6% [95% CI, 7.1%-8.1%]), bacteremia without meningitis (0.2% [95% CI, 0.1%-0.3%] vs 2.1% [95% CI, 1.8%-2.4%]), and bacterial meningitis (&lt;0.1% [95% CI, 0%-0.2%] vs 0.5% [95% CI, 0.4%-0.6%]). Among infants aged 29 to 60 days who tested positive for SARS-CoV-2, 0.4% (95% CI, 0.2%-0.7%) had UTI, less than 0.1% (95% CI, 0%-0.2%) had bacteremia, and less than 0.1% (95% CI, 0%-0.1%) had meningitis. Among SARS-CoV-2–positive infants, a lower proportion of those with normal IMs had bacteremia and/or bacterial meningitis compared with those with abnormal IMs (&lt;0.1% [0%-0.2%] vs 1.8% [0.6%-3.1%]).Conclusions and RelevanceThe prevalence of UTI, bacteremia, and bacterial meningitis was lower for febrile infants who tested positive for SARS-CoV-2, particularly infants aged 29 to 60 days and those with normal IMs. These findings may help inform management of certain febrile infants who test positive for SARS-CoV-2.

show abstract

“…Fever is a common cause of emergency department (ED) visits in young infants, and an estimated 100,000 infants younger than 60 days are evaluated for it in the ED each year in the United States. 1 Whereas most have a viral infection, about 9% have a serious bacterial infection (SBI) in the form of bacteremia (1.4%), bacterial meningitis (0.5%), or urinary tract infection (UTI) (8.3%). 2 Prompt recognition and early management of an SBI are crucial because of the potential for severe morbidity and mortality from delays in detection.…”

mentioning

confidence: 99%

Neonatal Fever in the COVID-19 Pandemic

et al. 2021

View full text Add to dashboard Cite

Objectives A sepsis workup is recommended in young infants 56 days or younger with fever to rule out a serious bacterial infection (SBI). Given the reduction in non–severe acute respiratory syndrome - coronavirus 2 viral infections observed in multiple studies during the coronavirus diseases 2019 (COVID-19) pandemic, we sought to determine if the reduction in viral infections led to a change in the incidence of SBI in this vulnerable patient population. Methods We performed a multicenter, retrospective study of infants 56 days or younger presenting with fever to emergency departments of 6 community hospitals. We compared the incidence of SBIs, viral meningitis, and viral bronchiolitis during March 2020 to February 2021 (pandemic year) with the same calendar months in the 2 preceding years (prepandemic years). Results From March 2018 to February 2021, 543 febrile infants presented to the emergency departments, 95 during the pandemic year (March 2020 to February 2021) compared with 231 and 217 in the prepandemic years (March 2018 to February 2019 and March 2019 to February 2020, respectively). During the pandemic year, 28.4% of infants (27 of 95) were diagnosed with an SBI compared with 11.7% and 6.9% ( P < 0.001) in the prepandemic years (27 of 231 and 15 of 217, respectively). Five patients were diagnosed with bacterial meningitis over the 3-year period, 4 of them during the pandemic year (4 of 95 [4.2%]). Positivity for viral cerebrospinal fluid polymerase chain reaction during the pandemic year was 6.4% (3 of 47) compared with 20.8% (25 of 120) and 20.4% (23 of 113) in prepandemic years ( P = 0.070). During the pandemic year, 2.1% (2 of 95) febrile young infants were admitted with a comorbid diagnosis of bronchiolitis compared with 4.3% and 6.0% in the prepandemic years ( P = 0.310). Conclusions The COVID-19 pandemic led to an increase in the incidence of SBIs in febrile infants 56 days or younger, likely a result of reduction in non–severe acute respiratory syndrome - coronavirus 2 viral infections. Greater vigilance is thus warranted in the evaluation of febrile infants during the COVID-19 pandemic.

show abstract

United States’ Emergency Department Visits for Fever by Young Children 2007-2017

Cited by 14 publications

References 30 publications

Pyrexia in a young infant – is height of fever associated with serious bacterial infection?

Pyrexia in a young infant – is height of fever associated with serious bacterial infection?

Prevalence of Urinary Tract Infection, Bacteremia, and Meningitis Among Febrile Infants Aged 8 to 60 Days With SARS-CoV-2

Neonatal Fever in the COVID-19 Pandemic

Contact Info

Product

Resources

About