Baker R C, Tiller T, Bausher J C, Bellet P S, Cotton W H, Finley A H, Lenane A M, McHenry C, Perez K K, Shapiro R A
Division of Ambulatory and Community Pediatrics, Children's Hospital Medical Center, Cincinnati, OH 45229-2899.
Pediatrics. 1989 Jun;83(6):1016-9.
A prospective study of the effects of fever reduction on the clinical appearance of infants at risk for occult bacteremia was undertaken to study the hypothesis that infants with bacteremic illness fail to improve clinically following defervescence compared with infants with benign viral illness. A total of 154 children were enrolled in the study, including 19 with bacteremia: 13 with occult Streptococcus pneumoniae bacteremia, two with occult Haemophilus influenzae, type b bacteremia, and four with Haemophilus meningitis and bacteremia. There were no differences in degree of temperature reduction with acetaminophen between the bacteremic and nonbacteremic groups of infants. Among infants with bacteremia but without meningitis, differences from nonbacteremic children were detected in clinical appearance prior to fever reduction but not following defervescence. All patients with meningitis appeared seriously ill before and after defervescence. It was concluded that clinical improvement with defervescence is not a reliable indicator of the presence of occult bacteremia. Lack of clinical improvement with defervescence may be a reliable indicator for the presence of meningitis. Because there were differences in clinical appearance prior to fever reduction, routine administration of acetaminophen may interfere with the clinical evaluation by the physician.
一项关于退热对有隐匿性菌血症风险婴儿临床表现影响的前瞻性研究展开，旨在验证以下假设：与患有良性病毒性疾病的婴儿相比，患有菌血症疾病的婴儿在退热后临床症状并无改善。共有154名儿童参与该研究，其中19名患有菌血症：13名患有隐匿性肺炎链球菌菌血症，2名患有隐匿性b型流感嗜血杆菌菌血症，4名患有流感嗜血杆菌脑膜炎和菌血症。菌血症组和非菌血症组婴儿使用对乙酰氨基酚降温的程度没有差异。在患有菌血症但没有脑膜炎的婴儿中，在退热前的临床表现与非菌血症儿童存在差异，但退热后则没有。所有患有脑膜炎的患者在退热前后均表现出病情严重。研究得出结论，退热后临床症状改善并非隐匿性菌血症存在的可靠指标。退热后缺乏临床症状改善可能是脑膜炎存在的可靠指标。由于退热前临床表现存在差异，常规使用对乙酰氨基酚可能会干扰医生的临床评估。
