Neonatal Fever in the COVID-19 Pandemic

Abstract

Objectives A sepsis workup is recommended in young infants 56 days or younger with fever to rule out a serious bacterial infection (SBI). Given the reduction in non–severe acute respiratory syndrome - coronavirus 2 viral infections observed in multiple studies during the coronavirus diseases 2019 (COVID-19) pandemic, we sought to determine if the reduction in viral infections led to a change in the incidence of SBI in this vulnerable patient population. Methods We performed a multicenter, retrospective study of infants 56 days or younger presenting with fever to emergency departments of 6 community hospitals. We compared the incidence of SBIs, viral meningitis, and viral bronchiolitis during March 2020 to February 2021 (pandemic year) with the same calendar months in the 2 preceding years (prepandemic years). Results From March 2018 to February 2021, 543 febrile infants presented to the emergency departments, 95 during the pandemic year (March 2020 to February 2021) compared with 231 and 217 in the prepandemic years (March 2018 to February 2019 and March 2019 to February 2020, respectively). During the pandemic year, 28.4% of infants (27 of 95) were diagnosed with an SBI compared with 11.7% and 6.9% ( P < 0.001) in the prepandemic years (27 of 231 and 15 of 217, respectively). Five patients were diagnosed with bacterial meningitis over the 3-year period, 4 of them during the pandemic year (4 of 95 [4.2%]). Positivity for viral cerebrospinal fluid polymerase chain reaction during the pandemic year was 6.4% (3 of 47) compared with 20.8% (25 of 120) and 20.4% (23 of 113) in prepandemic years ( P = 0.070). During the pandemic year, 2.1% (2 of 95) febrile young infants were admitted with a comorbid diagnosis of bronchiolitis compared with 4.3% and 6.0% in the prepandemic years ( P = 0.310). Conclusions The COVID-19 pandemic led to an increase in the incidence of SBIs in febrile infants 56 days or younger, likely a result of reduction in non–severe acute respiratory syndrome - coronavirus 2 viral infections. Greater vigilance is thus warranted in the evaluation of febrile infants during the COVID-19 pandemic.

High-Risk Markers and Infection Rates in Febrile Infants Aged 29 to 60 Days Presenting to an Emergency Department During the COVID-19 Pandemic

“…Our hospital's pathway for febrile infants aged 29 to 60 days used in this study was shown to reduce invasive interventions without any missed SBIs over the first year of implementation. 17 Our findings of a significant increase in 2 of these high-risk markers, WBC and UA, in 2020 support the increased attentiveness required in this patient population during the pandemic, as suggested by Mittal et al 18 Interestingly, we did not find a difference in the high-risk maker of ill appearance, which was possibly due to clinician subjectivity for this classification. Several limitations to this study should be noted.…”

“…18 This same study found a decrease in viral meningitis and an increase in bacterial meningitis in 2020, whereas we report no cases of meningitis in 2020. 18 A strength of this study is the evaluation of high-risk markers in addition to rates of infection. Growing evidence supports the use of laboratory testing to risk-stratify febrile infants to identity and promptly treat those with suspected SBI.…”

“…The hypothesis that steps to mitigate COVID-19 resulted in no significant decline in the rates of UTI, as shown in 4 large pediatric studies across the United States and France, is further supported by our study. [18][19][20][21] In fact, a multicenter study of febrile patients younger than 56 days similarly reported an increase in both bacteremia and UTI incidence during the pandemic year compared with prepandemic years. 18 This same study found a decrease in viral meningitis and an increase in bacterial meningitis in 2020, whereas we report no cases of meningitis in 2020.…”

“…[18][19][20][21] In fact, a multicenter study of febrile patients younger than 56 days similarly reported an increase in both bacteremia and UTI incidence during the pandemic year compared with prepandemic years. 18 This same study found a decrease in viral meningitis and an increase in bacterial meningitis in 2020, whereas we report no cases of meningitis in 2020. 18 A strength of this study is the evaluation of high-risk markers in addition to rates of infection.…”

Reduction in the duration of postoperative fever following NUSS surgery during the COVID-19 pandemic

“…Fever is a common complication in the early stages following the NUSS procedure, and fever is often associated with infection-related complications. We hypothesize that the decline in the frequency of postoperative fever observed during the epidemic was most likely related to the strengthening of personal protection measures for physicians, nurses, patients, and family members, including implementation of surgical masks, FFRs, and limiting the number of relatives allowed into inpatient departments, thus reducing the risk of pathogen exposure [9][10][11]. However, due to our failure to perform preoperative and postoperative respiratory tract or blood tract tests on patients with PE, we were unable to objectively obtain evidence of pathogen transmission.…”