Impact of the Step-by-Step on febrile infants

Gómez, Borja; Fernandez-Uria, Amaia; Benito, Javier; Lejarzegi, Ainara; Mintegi, Santiago

doi:10.1136/archdischild-2021-322475

Cited by 9 publications

(7 citation statements)

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“…The included studies were observational and case reports. Three were prospective, one was a prospective registry of febrile infants from one hospital with several publications [45][46][47] and the rest were retrospective. Two other reports were unpublished data presented in Pediatric Emergency Medicine meetings.…”

Section: Included Study Characteristicsmentioning

confidence: 99%

Prevalence of invasive bacterial infection in febrile infants ≤90 days with a COVID-19 positive test: a systematic review and meta-analysis

Pérez-Porra,

Granda,

Benito

et al. 2023

Emerg Med J

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BackgroundFebrile infants with an infection by influenza or enterovirus are at low risk of invasive bacterial infection (IBI).ObjectiveTo determine the prevalence of IBI among febrile infants ≤90 days old with a positive COVID-19 test.MethodsMEDLINE, Embase, Cochrane Central Register databases, Web of Science, ClinicalTrials.gov and grey literature were searched for articles published from February 2020 to May 2023. Inclusion criteria: researches reporting on infants ≤90 days of age with fever and a positive test for SARS-CoV-2 (antigen test/PCR). Case reports with <3 patients, articles written in a language other than English, French or Spanish, editorials and other narrative studies were excluded. Preferred Reposting Items for Systematic Reviews and Meta-analysis guidelines were followed, and the National Institutes of Health Quality Assessment Tool was used to assess study quality. The main outcome was the prevalence of IBI (a pathogen bacterium identified in blood and/or cerebrospinal fluid (CSF)). Forest plots of prevalence estimates were constructed for each study. Heterogeneity was assessed and data were pooled by meta-analysis using a random effects model. A fixed continuity correction of 0.01 was added when a study had zero events.ResultsFrom the 1023 studies and 3 databases provided by the literature search, 33 were included in the meta-analysis, reporting 3943 febrile infants with a COVID-19 positive test and blood or CSF culture obtained. The pooled prevalence of IBI was 0.14% (95% CI, 0.02% to 0.27%). By age, the prevalence of IBI was 0.56% (95% CI, 0.0% to 1.27%) in those 0–21 days old, 0.53% (95% CI, 0.0% to 1.22%) in those 22–28 days old and 0.11% (95% CI, 0.0% to 0.24%) in those 29–60 days old.ConclusionCOVID-19-positive febrile infants ≤90 days old are at low risk of IBI, especially infants >28 days old, suggesting this subgroup of patients can be managed without blood tests.PROSPERO registration numberCRD42022356507.

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Section: Included Study Characteristicsmentioning

confidence: 99%

Prevalence of invasive bacterial infection in febrile infants ≤90 days with a COVID-19 positive test: a systematic review and meta-analysis

Pérez-Porra,

Granda,

Benito

et al. 2023

Emerg Med J

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“…This guideline was an adjustment of the “Step-by-Step” approach ( 5 ). To the best of our knowledge, only a few studies have investigated the impact of new guidelines on the management of febrile infants ( 12 , 20 ). In this study, we aimed to describe the differences in the management and SBI diagnosis of febrile infants aged ≤59 days before and after the introduction of the new guideline.…”

Section: Introductionmentioning

confidence: 99%

“…guidelines for managing febrile infants aged ≤59 days have been developed over the last decades (5)(6)(7)(8). Guidelines have been associated with better patient outcome and improved resource utilization (9)(10)(11)(12). However, other studies have shown that guidelines did not improve the outcome of febrile infants but rather increased testing, antibiotic treatments, and hospitalizations (13)(14)(15).…”

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confidence: 99%

Low adherence to a new guideline for managing febrile infants ≤59 days

Elliver,

Norrman,

Orfanos

2024

Front. Pediatr.

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BackgroundManagement of young febrile infants is challenging. Therefore, several guidelines have been developed over the last decades. However, knowledge regarding the impact of introducing guidelines for febrile infants is limited. We assessed the impact of and adherence to a novel guideline for managing febrile infants aged ≤59 days.MethodsThis retrospective cross-sectional study was conducted in 2 pediatric emergency departments in Sweden between 2014 and 2021. We compared the management of infants aged ≤59 days with fever without a source (FWS) and the diagnosis of serious bacterial infections (SBIs) before and after implementing the new guideline.ResultsWe included 1,326 infants aged ≤59 days with FWS. Among infants aged ≤21 days, urine cultures increased from 49% to 67% (p = 0.001), blood cultures from 43% to 63% (p < 0.001), lumbar punctures from 16% to 33% (p = 0.003), and antibiotics from 38% to 57% (p = 0.002). Only 39 of 142 (28%) infants aged ≤21 days received recommended management. The SBI prevalence was 16.7% (95% CI, 11.0–23.8) and 17.6% (95% CI, 11.7–24.9) before and after the implementation, respectively. Among infants aged ≤59 days, there were 3 infants (0.6%; 95% CI, 0.1–1.7) in the pre-implementation period and 3 infants (0.6%; 95% CI, 0.1–1.7) in the post-implementation period with delayed treated urinary tract infections.ConclusionsInvestigations and antibiotics increased significantly after implementation of the new guideline. However, doing more did not improve the diagnosis of SBIs. Thus, the low adherence to the new guideline may be considered justified. Future research should consider strategies to safely minimize interventions when managing infants with FWS.

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“…[1][2][3][4][5] Management guidelines have been shown to improve the care of febrile infants, enhance patient safety, optimize resource utilization, and decrease variability in treatment and cost. [6][7][8][9][10] However, guidelines are often not applied in daily clinical practice and often takes time to be endorsed. 11,12 Barriers to the implementation and use of guidelines have been investigated, and several possible etiologic factors have been identi ed.…”

Section: Introduction Page 3/18mentioning

confidence: 99%

Physician's conceptions of the decision-making process when managing febrile infants ≤60 days old: a phenomenographic qualitative study

Orfanos

Lindkvist

Eklund

et al. 2023

Preprint

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Background The management of febrile infants aged ≤ 60 days and adherence to guidelines vary greatly. Our objective was to describe the process of decision-making when managing febrile infants aged ≤ 60 days and to describe the factors that influenced this decision. Methods We conducted 6 focus group discussions with 19 clinically active physicians in the pediatric emergency departments of 2 university hospitals in Skåne region, Sweden. We followed an inductive qualitative design, using a phenomenological approach. A second-order perspective was used, focusing on how physicians perceived the phenomenon (managing fever in infants) rather than the phenomenon itself. The transcribed interviews were analyzed using a 7-step approach. Results Performing a lumbar puncture (LP) was conceived as a complex, emotionally and mentally laden procedure and dominated the group discussions. Three central categories emerged as factors that influenced the decision-making process on whether to perform an LP: 1) a possible focus of infection that could explain the origin of the fever, 2) questioning whether the temperature at home reported by the parents was a fever, especially if it was ≤ 38.2°C, and 3) the infant’s general condition and questioning the need for LP in case of well-appearing infants. Around these 3 central categories evolved 6 secondary categories that influenced the decision-making process of whether to perform an LP or not: 1) the physicians’ desire to be able to trust their judgement, 2) fearing the risk of failure, 3) avoiding burdensome work, 4) taking others into account, 5) balancing guidelines and resources, and 6) seeing a need to practice and learn to perform LP. Conclusions The difficulty and emotional load of performing an LP were important factors that influenced the decision-making process regarding whether to perform an LP. Physicians highlighted the importance of being able to rely on their clinical judgment and make independent decisions. Guidelines may consider allowing a degree of flexibility and independent thinking to take into account patients’ characteristics and needs.

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Impact of the Step-by-Step on febrile infants

Cited by 9 publications

References 4 publications

Prevalence of invasive bacterial infection in febrile infants ≤90 days with a COVID-19 positive test: a systematic review and meta-analysis

Prevalence of invasive bacterial infection in febrile infants ≤90 days with a COVID-19 positive test: a systematic review and meta-analysis

Low adherence to a new guideline for managing febrile infants ≤59 days

Physician's conceptions of the decision-making process when managing febrile infants ≤60 days old: a phenomenographic qualitative study

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