Repeated inflammatory markers may be useful for assessing febrile infants aged 29–90 days during early hospital surveillance

Bellini, Tommaso; Papa, Riccardo; Calevo, Maria Grazia; Fueri, E.; Caruggi, Samuele; Bonato, Irene; Piccotti, Emanuela

doi:10.1111/apa.16682

Cited by 2 publications

(5 citation statements)

References 6 publications

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“…Given the known high prevalence of SBI in children aged ≤90 days and the understanding that inflammatory markers performed within 12 h of fever may not differentiate between common benign viral infections and SBI, it is noteworthy that we did not detect any secondary SBI [ 10 , 13 , 14 ]. In light of our results and literature data, we suggest that laboratory tests in COVID-19 infants should not be routinely performed except in selected cases (poor clinical condition, poor feeding, comorbidities, and clinical concerns) [ 11 ].…”

Section: Discussionmentioning

confidence: 86%

“…In addition to absolute values, we considered the cut-off values suggested for white blood cells (WBC), absolute neutrophil count (ANC), C-reactive protein (CRP), and PCT by previous authors [ 10 , 13 , 14 , 16 ].…”

Section: Discussionmentioning

confidence: 99%

“…Given the absence of specific guidelines, our standard practice was to hospitalize most positive infants and newborns for observation, following other guidelines for managing fever in patients aged ≤90 days [ 1 , 2 , 10 , 14 ]. This inclination is underlined by our multivariable analysis, where fever and lower age, along with poor feeding, emerged as independent factors influencing hospitalization.…”

Section: Discussionmentioning

confidence: 99%

“…In infants affected by COVID-19, fever emerges as the most common symptom and is one of the most frequent reasons for consultation in the pediatric emergency department (PED) [ 2 , 10 ].…”

Section: Introductionmentioning

confidence: 99%

“…Among these, the American Academy of Pediatrics guidelines and the “Step-by-Step” approach are the most commonly used, demonstrating a lower incidence of undiagnosed SBI, compared to other scoring systems [ 13 , 14 ]. However, these approaches have been reported to be less sensitive in children with a short duration of fever, often leading to hospitalization and a comprehensive sepsis workup [ 10 , 11 , 14 , 16 ]. Moreover, these algorithms do not include the use of rapid diagnostic tests for viral infections, including COVID-19 [ 11 , 13 , 14 ].…”

Section: Introductionmentioning

confidence: 99%

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Clinical Course, Laboratory Findings, and Prognosis of SARS-CoV-2 Infection in Infants up to 90 Days of Age: A Single-Center Experience and a Proposal for a Management Pathway

Bellini,

Brisca,

Orfanos

et al. 2024

Healthcare

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Aim: To provide a comprehensive description of the clinical features, biochemical characteristics, and outcomes of infants up to 90 days old with COVID-19. Moreover, to assess the severity of the disease and propose an effective management pathway. Methods: Retrospective single-center study spanning three years. Patient data includes age, sex, symptoms, comorbidities, blood and urine test results, cultures, admission, length of stay, therapies, intensive care unit admission, and mortality. Results: A total of 274 patients were enrolled in the study, comprising 55% males. Among them, 60 patients (22%) were under the age of 29 days, while 214 (78%) fell within the 29 to 90 days age range. The overall incidence of SARS-CoV-2 infections was 0.28 per 10,000 Pediatric Emergency Department admissions. Blood inflammatory markers showed no significant abnormalities, and there were no recorded instances of positive blood cultures. Less than 1% of infants showed urinary tract infections with positive urine cultures, and 1.5% of patients had a concurrent RSV infection. Hospitalization rates were 83% for neonates and 67% for infants, with a median length of stay (LOS) of 48 h for both age groups. None of the patients required admission to the Pediatric or Neonatal Intensive Care Unit, and only one required High Flow Nasal Cannula (HFNC). No secondary serious bacterial infections were observed, and all hospitalized patients were discharged without short-term sequelae. No deaths were reported. Discussion and Conclusions: Infants with COVID-19 generally exhibit milder or asymptomatic forms of the disease, making home management a viable option in most cases. Blood tests, indicative of a mild inflammatory response, are recommended primarily for children showing symptoms of illness. Hospitalization precautions for infants without apparent illness or comorbidities are deemed unnecessary. Given the evolving nature of experiences with COVID-19 in infants, maintaining a high level of clinical suspicion remains imperative.

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Section: Discussionmentioning

confidence: 86%

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

“…In infants affected by COVID-19, fever emerges as the most common symptom and is one of the most frequent reasons for consultation in the pediatric emergency department (PED) [ 2 , 10 ].…”

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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Clinical Course, Laboratory Findings, and Prognosis of SARS-CoV-2 Infection in Infants up to 90 Days of Age: A Single-Center Experience and a Proposal for a Management Pathway

Bellini,

Brisca,

Orfanos

et al. 2024

Healthcare

Self Cite

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Management of Febrile Infants Under 3 Months of Age with SARS-CoV-2 Infection in the Emergency Department

Diego,

Seguí,

Trenchs

et al. 2024

J Pediatr Infect Dis

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Objective Febrile infants with a proven viral infection are at lower risk for a potentially serious bacterial infection (SBI). Our objective is to describe the management of young febrile infants with COVID-19 in the emergency department. Methods Febrile infants <3 months with a positive PCR (polymerase chain reaction) test for SARS-CoV-2 between March 2020 and October 2022 were included in a cross-sectional study. The indication for complementary tests, hospital admission and antibiotic therapy was analyzed. We performed a global analysis and by age subgroups (<29 d and ≥29 d). Results A total of 172 patients were included in the study, out of which 32 (18.6%) were <29 days old. Bacterial cultures were performed on 160 patients (93%), with urine cultures being the most frequently requested (151 patients; 87.8%). Overall, 39 infants (22.7%) were hospitalized, and 17 infants (9.9%) received antibiotics. In the subgroup analysis, patients <29 days had performed more frequently urine culture (100 vs. 85%; p = 0.015), blood culture (96.9 vs. 43.6%; p < 0.001), and cerebrospinal fluid culture (18.8 vs. 1.4%; p < 0.001). They also had a higher admission rate (68.8 vs. 12.1%; p < 0.001) and antibiotic prescription (21.9 vs. 7.1%; p = 0.02). SBI was identified in 10 patients (9 with urinary infections and 1 with bacteremia), while no invasive bacterial infection (IBI) was diagnosed in patients aged ≥29 days. Conclusions The identification of SARS-CoV-2 led to less aggressive management in a significant number of cases compared with usual practice. The low prevalence of IBI would support its inclusion in the management algorithms for febrile infants, especially in patients aged ≥29 days. The nonnegligible prevalence of urinary infection would make it necessary to maintain its screening.

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Repeated inflammatory markers may be useful for assessing febrile infants aged 29–90 days during early hospital surveillance

Cited by 2 publications

References 6 publications

Clinical Course, Laboratory Findings, and Prognosis of SARS-CoV-2 Infection in Infants up to 90 Days of Age: A Single-Center Experience and a Proposal for a Management Pathway

Clinical Course, Laboratory Findings, and Prognosis of SARS-CoV-2 Infection in Infants up to 90 Days of Age: A Single-Center Experience and a Proposal for a Management Pathway

Management of Febrile Infants Under 3 Months of Age with SARS-CoV-2 Infection in the Emergency Department

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