Dorney Kate, Bachur Richard G
Division of Emergency Medicine, Boston Children's Hospital, Boston, Massachusetts, USA.
Curr Opin Pediatr. 2017 Jun;29(3):280-285. doi: 10.1097/MOP.0000000000000492.
The approach to febrile young infants remains challenging. This review serves as an update on the care of febrile infants less than 90 days of age with a focus on the changing epidemiology of serious bacterial infection (SBI), refinement of management strategies based on biomarkers, and the development of novel diagnostics.
There is high variability in the emergency department management of febrile young infants without significant differences in outcomes. C-reactive protein (CRP) and procalcitonin have emerged as valuable risk-stratification tests to identify high-risk infants. When interpreting automated urinalyses for suspected urinary tract infection (UTI), urine concentration influences the diagnostic value of pyuria. Novel diagnostics including RNA biosignatures and protein signatures show promise in better identifying young febrile infants at risk of serious infection.
The majority of febrile infants with an SBI will have a UTI but the diagnosis of invasive bacterial infection in infants continues to be challenging. The use of procalcitonin and CRP as biomarkers in prediction algorithms facilitates identification of low-risk infants.
处理发热的小婴儿仍然具有挑战性。本综述旨在更新对90日龄以下发热婴儿的护理，重点关注严重细菌感染（SBI）不断变化的流行病学、基于生物标志物的管理策略的完善以及新型诊断方法的开发。
发热小婴儿在急诊科的管理存在很大差异，但结局并无显著不同。C反应蛋白（CRP）和降钙素原已成为识别高危婴儿的有价值的风险分层检测指标。在解读疑似尿路感染（UTI）的自动尿液分析结果时，尿液浓度会影响脓尿的诊断价值。包括RNA生物标志物和蛋白质标志物在内的新型诊断方法在更好地识别有严重感染风险的发热小婴儿方面显示出前景。
大多数患有SBI的发热婴儿会发生UTI，但婴儿侵袭性细菌感染的诊断仍然具有挑战性。在预测算法中使用降钙素原和CRP作为生物标志物有助于识别低风险婴儿。
