Management of Hospitalized Febrile Neonates Without CSF Analysis: A Study of US Pediatric Hospitals

Abstract

A B S T R A C T OBJECTIVE:Management of febrile neonates includes obtaining blood, urine, and cerebrospinal fluid (CSF) cultures with hospitalization for empiric parenteral antibiotic therapy. Outcomes and management for neonates were compared based on whether CSF was obtained. METHODS: This multicenter retrospective review of the 2002 to 2012 Pediatric HealthInformation System database included hospitalized infants aged #28 days (neonates) admitted to an inpatient ward with a diagnosis code for fever or neonatal fever. Patients admitted to an ICU or with a complex chronic condition diagnosis code were excluded. Neonates were categorized as full septic workup (FSW; charge codes for blood, urine, and CSF culture or cell count) or as partial septic workup (PSW; charge codes for blood and urine cultures only), and their data were compared. RESULTS:Of 27 480 neonates with a diagnosis code for fever, 14 774 underwent the FSW and 3254 had a PSW. Median length of stay was 2 days for both groups, with no significant difference in readmissions, disposition, or parenteral antibiotic administration. Neonates with a PSW had significantly greater odds of having charge codes for additional laboratory testing and imaging, and they were more likely to receive a diagnosis code for sepsis, meningitis, or bronchiolitis. CONCLUSIONS:Neonates with PSW had lengths of stay and readmission rates similar to those with FSW but were more likely to undergo additional laboratory testing and imaging. Future studies including information about clinical severity and test results may provide additional insight into the variation in practice for this patient population.

Outcome of Treated Paediatric Clinical Meningitis, With and Without Cerebro Spinal Fluid (CSF) Analysis at a Tertiary Care Hospital of Karachi

“…Also, there is no agreement as to what comprises a genuine risk of meningitis to justify a CSF in the absence of sufficient evidence. Published literature supports our observations and suggests a risk of 1 in 12 risk if the diagnosis of meningitis is missed or is delayed [17]. Despite efforts taken by WHO to publish material for childcare and health especially for developing world e.g.…”

“…In this study we included children with or without CSF analysis, with febrile seizure also, especially those who were less than one year of age and/or were sick and /or whom there was even a slight clinical suspicion of meningitis. Other published guidelines [1] and data [15,16] supports this approach also. It was difficult to evaluate the role of immunization in children to prevent meningitis as most of our children had incomplete immunization.…”

Management and Outcomes of Previously Healthy, Full-Term, Febrile Infants Ages 7 to 90 Days

“…Standard definitions of bacteremia, UTI, and meningitis have been previously defined. 2,22,28 For all febrile infants, clinic notes of all visits and cultures obtained for the next month were reviewed. Recent immunization was defined as immunization in previous 48 hours to fever presentation.…”

Epidemiology of Bacteremia in Febrile Infants Aged 60 Days and Younger

“…As bacteremia and bacterial meningitis rates have decreased in the past decade, some clinicians are more selectively using laboratory testing to screen for bacterial illnesses in young febrile infants. 4–6, 8 Although bacteremia and bacterial meningitis are relatively uncommon, missed diagnosis can have serious long-term sequelae. Additional up-to-date information about the prevalence and epidemiology of bacteremia and bacterial meningitis among young, febrile infants will help to inform clinical evaluation and decision-making.…”