Evaluation and Management of Febrile, Well-appearing Young Infants

Biondi, Eric; Byington, Carrie L.

doi:10.1016/j.idc.2015.05.008

Cited by 49 publications

(55 citation statements)

References 51 publications

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“…Many febrile infants in this age group will have no focus of infection on physical examination, but ~10% will have an underlying serious bacterial infection (SBI). 62 The majority of these are urinary tract infections (7–9 % overall) whereas meningitis represents < 0.5%. This opens the door to a wide variety of practice patterns when it comes to deciding when it is appropriate to perform a LP.…”

Section: Special Situationsmentioning

confidence: 99%

“…This opens the door to a wide variety of practice patterns when it comes to deciding when it is appropriate to perform a LP. 62–64 As infants < 28 days are at greater risk for SBI (overall prevalence of 11–25%), the general consensus favors performing a LP in all cases and admitting to the hospital pending culture results. 62 Well-appearing febrile infants 28–90 days old present more of a management dilemma.…”

Section: Special Situationsmentioning

confidence: 99%

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Diagnosis and Treatment of Central Nervous System Infections in the Emergency Department

Dorsett

Liang

2016

Emergency Medicine Clinics of North America

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Central nervous system (CNS) infections, including meningitis, encephalitis, and brain abscess, are rare but time-sensitive emergency department (ED) diagnoses. Patients with CNS infection can present to the ED with a host of non-specific signs and symptoms, including headache, fever, altered mental status, and behavioral changes. In meningitis, the classic triad of fever, neck stiffness, and altered mental status occurs in only a minority of patients. Classic physical examination maneuvers, such Kernig’s and Brudzinski’s signs, are relatively insensitive although specific for predicting cerebrospinal fluid (CSF) pleocytosis. Patients with parenchymal involvement, as occurs with encephalitis and brain abscess, may also have focal neurologic deficits or seizures. Neuroimaging and CSF fluid analysis can appear benign early in the course of meningitis and encephalitis, and clinicians should not be falsely reassured. Delaying antibiotic and antiviral therapies negatively impacts outcomes, particularly with bacterial meningitis and herpes simplex virus encephalitis. As with other rare, life-threatening diagnoses encountered in emergency medicine, the diagnosis and treatment of CNS infections requires vigilance and a high index of suspicion based on the history and physical examination which must be confirmed with appropriate imaging and laboratory evaluation.

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Section: Special Situationsmentioning

confidence: 99%

Section: Special Situationsmentioning

confidence: 99%

Diagnosis and Treatment of Central Nervous System Infections in the Emergency Department

Dorsett

Liang

2016

Emergency Medicine Clinics of North America

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“…Criterios de bajo riesgo de IBG en lactantes de 30 a 90 días que pueden ser atendidos en forma ambulatoria, aun sin tratamiento antibiótico: 3,16,[30][31][32][33] • Buen estado general, sin signos de infección.…”

Section: B Lactantes De 30 a 90 Díasunclassified

Consenso para el uso adecuado de antibióticos en el niño menor de 36 meses con fiebre sin foco de infección evidente. Texto completo

2017

Arch Argent Pediat

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“…Also, setting a correct diagnosis is especially challenging because symptoms and signs of infection in children this age are most often non-specific, with elevated body temperature often as the only symptom, especially on examination at the initial stages of disease 5,6 .…”

mentioning

confidence: 99%

“…Because of that, extensive laboratory testing is often carried out, along with initiation of empirical intravenous antibiotic therapy consequently requiring hospitalization 5 . That practice, in addition to the increased risk of side-effects and allergic reactions, also raises the medical costs and increases bacterial resistance to most commonly used antibiotics 7 .…”

mentioning

confidence: 99%

New prediction model for diagnosis of bacterial infection in febrile infants younger than 90 days

2017

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Due to non-specific clinical presentation in febrile infants, extensive laboratory testing is often carried out to distinguish simple viral disease from serious bacterial infection (SBI). Objective of this study was to compare efficacy of different biomarkers in early diagnosis of SBI in infants <90 days old. Also, we developed prediction models with whom it will be possible to diagnose SBI with more accuracy than with any biomarkers independently.Febrile <90-day-old infants hospitalized in 2-year-period at Department of Pediatrics, University Hospital Centre Split with suspicion of having SBI were included in this study. Retrospective cohort analysis of data acquired from medical records was performed. Out of 181 enrolled patients, SBI was confirmed in 70. Most common diagnosis was urinary tract infection (68.6%), followed by pneumonia (12.9%), sepsis (11.4%), gastroenterocolitis (5.7%) and meningitis (1.4%). Male gender was shown to be a risk factor for SBI in this population (p=0.008). White blood cell count (WBC), absolute neutrophil count (ANC) and C-reactive protein (CRP) were confirmed as the independent predictors of SBI, with CRP as the best one. Two prediction models built by combining biomarkers and clinical variables were selected as optimal with sensitivities of 74.3% and 75.7%, and specificities of 88.3% and 86%. Evidently, CRP is a more superior biomarker in diagnostics of SBI comparing to WBC and ANC. Prediction models were shown to be better in predicting SBI than independent biomarkers. Although both showed high sensitivity and specificity, their true strength should be determined using validation cohort.

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Evaluation and Management of Febrile, Well-appearing Young Infants

Cited by 49 publications

References 51 publications

Diagnosis and Treatment of Central Nervous System Infections in the Emergency Department

Diagnosis and Treatment of Central Nervous System Infections in the Emergency Department

Consenso para el uso adecuado de antibióticos en el niño menor de 36 meses con fiebre sin foco de infección evidente. Texto completo

New prediction model for diagnosis of bacterial infection in febrile infants younger than 90 days

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