Length of Stay and Complications Associated With Febrile Infants <90 Days of Age Hospitalized in the United States, 2000–2012

Abstract

A B S T R A C TOBJECTIVES: It is not known how changes in the epidemiology of serious bacterial infection (SBI) and greater availability of rapid viral diagnostic tests have impacted the hospital length of stay (LOS) and associated complications among young infants with suspected SBI. METHODS:We used national administrative data from the Healthcare Cost and Utilization Project Kids' Inpatient Database and other state-specific data to identify febrile infants ,90 days of age hospitalized in 2000, 2003, 2006, 2009, and 2012. We used multivariate analysis to determine LOS, risk factors for prolonged LOS, and complications of care among infants with isolated fever or viral respiratory disease, without concomitant serious infection. RESULTS:We identified 44 875 infants. LOS for each clinical group did not change over time in a clinically significant way. Mean LOS was #2 days for approximately two-thirds of all infants and $4 days for 11% in each clinical group. Factors associated with longer LOS included age ,31 days, critical clinical status, concomitant chronic disease, and the presence of complications (P , .05). We identified 289 (0.8%) infants with 351 complications of care, 18 (6%) of whom had .1. These infants had longer LOS (P , .001), and those with chronic disease and older age were at increased risk (P , .01). CONCLUSIONS:Despite the changing epidemiology of SBI and increased availability of viral diagnostic testing, we did not detect a clinically significant change in LOS for febrile infants with suspected SBI. Complications associated with hospitalization of these infants was associated with increased LOS.

Incidence, clinical profile, and risk factors for serious bacterial infections in children hospitalized with fever in Ujjain, India

“…A history of previous hospitalization increased the risk for SBI 15-fold ( Table 2). Another study reported a 3-fold increase in the risk of SBI in patients with a history of hospitalization [30]. Furthermore, SBI risk in chronic diseases, such as tuberculosis, HIV infection, and diabetes, was reported [7].…”

“…A high prevalence (50-64%) of respiratory symptoms in children with SBI has been reported [33]. Up to 78% of febrile children reported SBI with poor feeding and 76% children reported SBI with irritability [30]. Suspected UTI was reported as the main presenting complaint in approximately 70% of the patients diagnosed with SBI [30].…”

“…Up to 78% of febrile children reported SBI with poor feeding and 76% children reported SBI with irritability [30]. Suspected UTI was reported as the main presenting complaint in approximately 70% of the patients diagnosed with SBI [30]. A "sick-looking/toxic looking" child is a common general examination finding in children with confirmed bacterial infections [18,33,34].…”

Clinical management and outcomes for febrile infants 29–60 days evaluated in community emergency departments

“…This cutoff was based on a traditional 48-hour rule-out for infants with bacterial cultures. 17,18 After identifying clinically relevant variables, stepwise selection (entry = 0.15, stay = 0.20)…”

“…This cutoff was based on a traditional 48‐hour rule‐out for infants with bacterial cultures. 17 , 18 After identifying clinically relevant variables, stepwise selection (entry = 0.15, stay = 0.20) was used to identify the variables for the final model. LP within 2 hours of antibiotic administration was added, as well as race and ethnicity, to accomplish the primary outcome analysis and to account for any potential inequities that have been reported in the literature over the time period of the study.…”