Diagnostic Value of Leukopenia in YOUNG Febrile Infants

Gómez, Borja; Mintegi, Santiago; López, Éder Iván Zamarrón; Romero, Ana L.; Paniagua, Natalia; Benito, Javier

doi:10.1097/inf.0b013e3182337ddb

Cited by 10 publications

(7 citation statements)

References 10 publications

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“…However, the value of these tests is controversial. Recent studies have shown that white blood cell (WBC) count has a poor value in the diagnosis of bacteraemia and other bacterial infections in these infants 7 8. In fact, WBC count has been relegated in the more recently developed scores to identify patients at higher risk for SBI9 10 and newer biomarkers as C reactive protein (CRP)10 and, mainly, procalcitonin (PCT)11 seem to be more useful to identify febrile young infants with bacterial infections 2 12…”

Section: Introductionmentioning

confidence: 99%

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

et al. 2013

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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.

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Section: Introductionmentioning

confidence: 99%

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

et al. 2013

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“…Gomez et al, 42 Gomez et al, 43 Mintegi et al, 44 sensitivity analyses did not differ significantly, lending confidence to findings of the primary analyses (Table 2).…”

Section: Resultsmentioning

confidence: 66%

Prevalence of Bacterial Meningitis Among Febrile Infants Aged 29-60 Days With Positive Urinalysis Results

et al. 2021

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IMPORTANCE Fever in the first months of life remains one of the most common pediatric problems.Urinary tract infections are the most frequent serious bacterial infections in this population. All published guidelines and quality initiatives for febrile young infants recommend lumbar puncture (LP) and cerebrospinal fluid (CSF) testing on the basis of a positive urinalysis result to exclude bacterial meningitis as a cause. For well infants older than 28 days with an abnormal urinalysis result, LP remains controversial.OBJECTIVE To assess the prevalence of bacterial meningitis among febrile infants 29 to 60 days of age with a positive urinalysis result to evaluate whether LP is routinely required.DATA SOURCES MEDLINE and Embase were searched for articles published from January 1, 2000, to July 25, 2018, with deliberate limitation to recent studies. Before analysis, the search was repeated (October 6, 2019) to ensure that new studies were included.STUDY SELECTION Studies that reported on healthy, full-term, well-appearing febrile infants 29 to 60 days of age for whom patient-level data could be ascertained for urinalysis results and meningitis status were included. DATA EXTRACTION AND SYNTHESIS Data were extracted in accordance with Preferred ReportingItems for Systematic Reviews and Meta-analyses (PRISMA) guidelines and used the Newcastle-Ottawa Scale to assess bias. Pooled prevalences and odds ratios (ORs) were estimated using randomeffect models. MAIN OUTCOMES AND MEASURESThe primary outcome was the prevalence of culture-proven bacterial meningitis among infants with positive urinalysis results. The secondary outcome was the prevalence of bacterial meningitis, defined by CSF testing or suggestive history at clinical follow-up. RESULTSThe parent search yielded 3227 records; 48 studies were included (17 distinct data sets of 25 374 infants). The prevalence of culture-proven meningitis was 0.44% (95% CI, 0.25%-0.78%) among 2703 infants with positive urinalysis results compared with 0.50% (95% CI, 0.33%-0.76%) among 10 032 infants with negative urinalysis results (OR, 0.74; 95% CI, 0.39-1.38). The prevalence of bacterial meningitis was 0.25% (95% CI, 0.14%-0.45%) among 4737 infants with meningitis status ascertained by CSF testing or clinical follow-up and 0.28% (95% CI, 0.21%-0.36%) among 20 637 infants with positive and negative urinalysis results (OR, 0.89; 95% CI, 0.48-1.68). CONCLUSIONS AND RELEVANCEIn this systematic review and meta-analysis, the prevalence of bacterial meningitis in well-appearing febrile infants 29 to 60 days of age with positive urinalysis (continued) Key Points Question Are well-appearing febrile infants 29 to 60 days of age with positive urinalysis results at increased risk for bacterial meningitis? Findings In a systematic review and meta-analysis of 17 distinct international data sets (25 374 infants), the pooled prevalence of bacterial meningitis among infants with positive urinalysis results ranged from 0.25% (by cerebrospinal fluid [CSF] cultures or clinical definition) to 0.44% (by CS...

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“…Curiously, leukopenia in well-appearing infants was not found to be a risk factor for a poor outcome, thus contrasting with previous reports. 22,23 On the one hand, a significant number of GBS colonizations were isolated in locations other than the blood (20, 16.9%), mainly CSF (17, 14.4%). This reaffirms the current recommendation to perform a lumbar puncture, if it has not been done before, when GBS bacteremia is identified in infants under 3 months of age.…”

Section: Discussionmentioning

confidence: 99%

Late-onset Group B Streptococcus Bacteremia Evaluated in the Pediatric Emergency Department and Risk Factors for Severe Infection

Ecclesia

Cadenas

Gómez

et al. 2022

Pediatric Infectious Disease Journal

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Background: To describe the infants presenting to pediatric emergency departments (PEDs) and diagnosed with group B Streptococcus (GBS) late-onset disease (LOD) bacteremia and identify risk factors for severe infection and pediatric intensive care unit (PICU) admission. Methods: Observational study and subanalysis of a multicenter prospective registry. Setting: pediatric emergency department. Inclusion criteria: infants between 7 and 89 days of age with positive blood culture for GBS seen between 2011 and 2016 at any of 22 Spanish PEDs. Main outcome: risk factors (clinical and laboratory variables) for severe infection (sepsis/septic shock or meningitis) and PICU admission. Second, the prevalence of poor outcomes (acute complications, sequelae or death). Results: Among 118 patients with LOD, 74 (62.7%) presented a severe infection: 66 sepsis/septic shock (11 with associated meningitis) and 8 meningitis. Thirty-five patients (29.7%) were admitted to a PICU. An altered Pediatric Assessment Triangle (PAT) upon arrival and leukopenia were the only independent risk factors for severe infection [odds ratio (OR): 43.6; 95% confidence interval (CI): 8.1–235.7, P < 0.01] and PICU admission (OR: 11.6; 95% CI: 1.5–91.4; P < 0.019), respectively. Six patients (5.1%) developed a poor outcome, including 2 deaths (1.7%); all had an altered PAT, elevated procalcitonin (range 4.7–100 ng/ml), and were diagnosed with sepsis/septic shock and admitted to a PICU. Four developed leukopenia. Conclusions: Infants with GBS LOD frequently develop sepsis/septic shock and bacterial meningitis, associated with non-negligible morbidity and mortality. Clinical appearance was the only risk factor for severe infection, whereas leukopenia was related to PICU admission.

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Diagnostic Value of Leukopenia in YOUNG Febrile Infants

Cited by 10 publications

References 10 publications

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

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

Prevalence of Bacterial Meningitis Among Febrile Infants Aged 29-60 Days With Positive Urinalysis Results

Late-onset Group B Streptococcus Bacteremia Evaluated in the Pediatric Emergency Department and Risk Factors for Severe Infection

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