Febrile children with comorbidities at the emergency department — a multicentre observational study

Borensztajn, Dorine; Hagedoorn, Nienke N.; Carrol, Enitan D.; Both, Ulrich von; Emonts, Marieke; Flier, Michiel van der; Groot, Ronald de; Herberg, Jethro; Kohlmaier, Benno; Levin, Michael; Lim, Emma; Maconochie, Ian; Martinón-Torres, Federico; Nijman, Ruud; Pokorn, Marko; Rivero‐Calle, Irene; Τσολιά, Μαρία; Velden, Fabian van der; Vermont, Clementien; Zavadska, Dace; Zenz, Werner; Zachariasse, Joany M; Moll, Henriëtte A.

doi:10.1007/s00431-022-04552-2

Cited by 9 publications

(10 citation statements)

References 39 publications

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“…Complex comorbidities render a growing number of children who attend the emergency department (ED) at increased risk of infection [ 1 ]. This includes children with primary (PID) or acquired immunodeficiencies, but also those who are dependent on total parenteral nutrition (TPN) with central venous lines.…”

Section: Introductionmentioning

confidence: 99%

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Febrile illness in high-risk children: a prospective, international observational study

et al. 2022

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To assess and describe the aetiology and management of febrile illness in children with primary or acquired immunodeficiency at high risk of serious bacterial infection, as seen in emergency departments in tertiary hospitals. Prospective data on demographics, presenting features, investigations, microbiology, management, and outcome of patients within the ‘Biomarker Validation in HR patients’ database in PERFORM, were analysed. Immunocompromised children (< 18 years old) presented to fifteen European hospitals in nine countries, and one Gambian hospital, with fever or suspected infection and clinical indication for blood investigations. Febrile episodes were assigned clinical phenotypes using the validated PERFORM algorithm. Logistic regression was used to assess the effect size of predictive features of proven/presumed bacterial or viral infection. A total of 599 episodes in 482 children were analysed. Seventy-eight episodes (13.0%) were definite bacterial, 67 episodes probable bacterial (11.2%), and 29 bacterial syndrome (4.8%). Fifty-five were definite viral (9.2%), 49 probable viral (8.2%), and 23 viral syndrome (3.8%). One hundred ninety were unknown bacterial or viral infections (31.7%), and 108 had inflammatory or other non-infectious causes of fever (18.1%). Predictive features of proven/presumed bacterial infection were ill appearance (OR 3.1 (95% CI 2.1–4.6)) and HIV (OR 10.4 (95% CI 2.0–54.4)). Ill appearance reduced the odds of having a proven/presumed viral infection (OR 0.5 (95% CI 0.3–0.9)). A total of 82.1% had new empirical antibiotics started on admission (N = 492); 94.3% proven/presumed bacterial (N = 164), 66.1% proven/presumed viral (N = 84), and 93.2% unknown bacterial or viral infections (N = 177). Mortality was 1.9% (N = 11) and 87.1% made full recovery (N = 522). Conclusion: The aetiology of febrile illness in immunocompromised children is diverse. In one-third of cases, no cause for the fever will be identified. Justification for standard intravenous antibiotic treatment for every febrile immunocompromised child is debatable, yet effective. Better clinical decision-making tools and new biomarkers are needed for this population. What is Known:• Immunosuppressed children are at high risk for morbidity and mortality of serious bacterial and viral infection, but often present with fever as only clinical symptom.• Current diagnostic measures in this group are not specific to rule out bacterial infection, and positivity rates of microbiological cultures are low. What is New:• Febrile illness and infectious complications remain a significant cause of mortality and morbidity in HR children, yet management is effective.• The aetiology of febrile illness in immunocompromised children is diverse, and development of pathways for early discharge or cessation of intravenous antibiotics is debatable, and requires better clinical decision-making tools and biomarkers.

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Section: Introductionmentioning

confidence: 99%

“…This includes children with primary (PID) or acquired immunodeficiencies, but also those who are dependent on total parenteral nutrition (TPN) with central venous lines. They are at high risk (HR) for serious bacterial infection (SBI) and life-threatening infectious complications [ 1 , 2 ]. Some of these children are neutropenic.…”

Section: Introductionmentioning

confidence: 99%

Febrile illness in high-risk children: a prospective, international observational study

et al. 2022

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“…Studying a larger sample with febrile children with and without comorbidity could further clarify this. We deliberately did not exclude children with comorbidity because these form a substantial part of febrile children attending the ED and therefore should not be left out of scientific studies 25 …”

Section: Discussionmentioning

confidence: 99%

“…We deliberately did not exclude children with comorbidity because these form a substantial part of febrile children attending the ED and therefore should not be left out of scientific studies. 25 Another limitation is that cardiac tests were not routinely performed and thus were only performed in a minority of patients. This is due to the retrospective nature of the study and perhaps due to the low index of suspicion of severe or primary cardiac disease in many (ED) patients.…”

Section: Strengths and Limitationsmentioning

confidence: 99%

Elevated High-Sensitivity Troponin and NT-proBNP Values in Febrile Children

Borensztajn,

Tan,

de Rijke

et al. 2023

Pediatr Emer Care

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Objectives The COVID-19 pandemic and subsequent rise of multisystem inflammatory syndrome in children have raised interest in high-sensitivity troponin (hs-TnT) and N-terminal probrain natriuretic peptide (NT-proBNP) because these have been found to be elevated in many cases of multisystem inflammatory syndrome in children. Our aim was to study hs-TnT and NT-proBNP concentrations in febrile children not affected by COVID-19. Methods We retrospectively measured cardiac markers, hs-TnT, and NT-proBNP in leftover blood samples of febrile children (0–18 years) diagnosed and treated in a single-center emergency department (ED) (N = 67) and pediatric intensive care unit (PICU) (N = 19) that participated in a multicenter, prospective study of infection biomarkers (PERFORM). Results Concentrations of hs-TnT, median 1.8 ng/L (interquartile range [IQR], 0.0–15.1), and NT-proBNP, 194 pg/mL (IQR, 54.9–706), were higher in febrile children than in controls (N = 25, hs-TnT 0.0 [IQR, 0–0]; NT-proBNP 56.3 [IQR, 29.7–109], both P < 0.001), whereas PICU patients had higher concentrations (hs-TnT 15.1 [IQR, 10.3–102] and NT-proBNP 828 [IQR, 657–4712], both P < 0.001) than ED patients (hs-TnT 0 [IQR, 0–7.4] and NT-proBNP 104 [IQR, 39.5–363]). No differences were found between viral and bacterial infections. Highest concentrations were found in children with either comorbidity predisposing to elevated concentrations (eg, chronic cardiac or renal disease) or children with critical illness or multiorgan failure such as those with septic shock. Conclusions Concentrations of hs-TnT and NT-proBNP are often elevated in febrile children with different causes of fever. Concentrations were higher in children admitted to the PICU than in children attending the ED, and seem to reflect disease severity rather than the underlying cause of fever.

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“…Febrile UTIs are a common symptom in children with structural renal abnormalities and vesico-ureteral reflux (VUR). Similarly, UTIs can be brought on by obstructive anomalies [4]. Long-term consequences include kidney scarring, hypertension, and chronic renal insufficiency, whereas short-term complications include severe pyelonephritis or sepsis [5].…”

Section: Introductionmentioning

confidence: 99%

Frequency of Urinary Tract Infection in Febrile Children without Any Focus on Infection

Jogezai¹,

Zahra²,

Fatima³

2022

PJMHS

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Background: In newborns and young children, a urinary tract infection is a frequent hidden cause of fever. Children younger than a year old who appear with fever and symptoms of UTI are usually given treatment for something else. Objectives: The objective of this study was to assess the prevalence of UTI in children presenting to a tertiary care hospital between the ages of 1 month and 36 months with nonspecific fever. Duration and study settings: The Children's Hospital Pakistan Institute of Medical Science, SZABMU, Islamabad, was the site of this trial, which ran from Jan 2018 to June 2018. Study design: Descriptive cross sectional Methodology: After a complete medical history and physical examination, a urine sample was taken for testing and culture using a soft tube in younger children and a clean catch approach in older children or those who are cooperative. Urisys 2400 was used to analyse the urine samples. Larger children's urine samples were grown on CLED agar plates (cysteine lactose, electrolyte deficient). Clinitek Siemens, a haematology analyser, was used to determine the number of white blood cells in the blood. The Pakistan Institute of Medical Sciences in Islamabad is home to a state-of-the-art laboratory where tests including leucocyte count, urine DR, and culture were conducted. A pre-designed proforma was used to record the patient's demographic information, medical history, diagnosis, and laboratory results. Results: In this study, 6.47 percent (n=18) of 278 children aged 1 to 36 who presented to a tertiary care hospital with a fever and no other obvious signs of infection were found to have a urinary tract infection. Conclusion: Children arriving to a tertiary care hospital with a fever and no other signs of infection are not likely to have a urinary tract infection. Keywords: UTI in children with diffuse fever and no obvious source of infection.

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Febrile children with comorbidities at the emergency department — a multicentre observational study

Cited by 9 publications

References 39 publications

Febrile illness in high-risk children: a prospective, international observational study

Febrile illness in high-risk children: a prospective, international observational study

Elevated High-Sensitivity Troponin and NT-proBNP Values in Febrile Children

Frequency of Urinary Tract Infection in Febrile Children without Any Focus on Infection

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