Stanley Rachel, Pagon Zrinka, Bachur Richard
Department of Emergency Medicine, Hurley Medical Center, University of Michigan, Ann Arbor, MI, USA.
Pediatr Emerg Care. 2005 May;21(5):291-4. doi: 10.1097/01.pec.0000159073.47691.38.
To determine the prevalence of serious bacterial infection in infants younger than 3 months with fever > or =40 degrees C.
We retrospectively identified all infants younger than 3 months with fever who presented to a pediatric emergency department. The medical records were reviewed. The prevalence of serious bacterial infection (SBI) among those patients with hyperpyrexia was compared with febrile infants with lower fever.
5279 infants younger than 3 months with fever were reviewed. Ninety-eight patients (1.7%) had triage temperature > or =40 degrees C rectally. Median age, temperature, and white blood count for those with hyperpyrexia were 58 days (interquartile range [IQR] 36-78 days), 40.2 degrees C (IQR, 40.0-40.4 degrees C), and 10,800/mm3 (IQR, 7900-14,600/mm3), respectively. Diagnostic studies included blood culture (100%), urine culture (100%), lumbar puncture (100%), chest radiographs (34%), and stool cultures (11%). SBI was found in 38% infants with hyperpyrexia: urinary tract infection was the most common SBI (71%). Among patients with hyperpyrexia, patients with SBI had similar mean white blood cell counts (14,000 vs. 10,200 cells/mm3) and age (54 vs. 53 days) as those with hyperpyrexia but no SBI. The prevalence of SBI among febrile infants with temperatures > or =40.0 degrees C was 38% (95% CI 27-48%) compared with those with fever < or =40 degrees C: 8.8% (95% CI 8.1-9.5%).
Hyperpyrexia is rare among febrile infants younger than 3 months. One-third of infants with temperature > or =40.0 degrees C had SBI. Future management algorithms might include hyperpyrexia as a risk factor for serious infection.
确定体温≥40℃的3个月以下发热婴儿中严重细菌感染的患病率。
我们回顾性地确定了所有到儿科急诊科就诊的3个月以下发热婴儿。对病历进行了审查。将高热婴儿中严重细菌感染（SBI）的患病率与低热的发热婴儿进行比较。
对5279名3个月以下发热婴儿进行了审查。98名患者（1.7%）直肠分诊温度≥40℃。高热患者的中位年龄、体温和白细胞计数分别为58天（四分位间距[IQR]36 - 78天）、40.2℃（IQR，40.0 - 40.4℃）和10,800/mm³（IQR，7900 - 14,600/mm³）。诊断性检查包括血培养（100%）、尿培养（100%）、腰椎穿刺（100%）、胸部X线片（34%）和粪便培养（11%）。38%的高热婴儿发现有SBI：尿路感染是最常见的SBI（71%）。在高热患者中，有SBI的患者与无SBI的高热患者的平均白细胞计数（14,000对10,200个细胞/mm³）和年龄（54对53天）相似。体温≥40.0℃的发热婴儿中SBI的患病率为38%（95%CI 27 - 48%），而体温≤40℃的发热婴儿中SBI的患病率为8.8%（95%CI 8.1 - 9.5%）。
3个月以下发热婴儿中高热很少见。三分之一体温≥40.0℃的婴儿患有SBI。未来的管理算法可能将高热作为严重感染的一个危险因素。
