Woll Christopher, Neuman Mark I, Aronson Paul L
*Fellow (Woll), Assistant Professor (Aronson), Departments of Pediatrics and of Emergency Medicine, Section of Pediatric Emergency Medicine, Yale School of Medicine, New Haven, CT; and †Associate Professor (Neuman), Division of Emergency Medicine, Department of Pediatrics, Boston Children's Hospital, Harvard Medical School, Boston, MA.
Pediatr Emerg Care. 2017 Nov;33(11):748-753. doi: 10.1097/PEC.0000000000001303.
Infants aged 90 days or younger with fever are frequently evaluated in the pediatric emergency department. Physical examination findings and individual laboratory investigations are not reliable to differentiate benign viral infections from serious bacterial infections in febrile infants. Clinical prediction models were developed more than 25 years ago and have high sensitivity but relatively low specificity to identify bacterial infections in febrile infants. Newer laboratory investigations such as C-reactive protein and procalcitonin have favorable test characteristics compared with traditional laboratory studies such as a white blood cell count. These novel biomarkers have not gained widespread acceptance because of lack of robust prospectively collected data, varying thresholds to define positivity, and differing inclusion criteria across studies. However, C-reactive protein and procalcitonin, when combined with other patient characteristics in the step-by-step approach, have a high sensitivity for detection of serious bacterial infection. The RNA biosignatures are a novel biomarker under investigation for detection of bacterial infection in febrile infants.
90日龄及以下发热婴儿常在儿科急诊科接受评估。体格检查结果和单项实验室检查对于区分发热婴儿的良性病毒感染和严重细菌感染并不可靠。临床预测模型在25年多以前就已开发出来，在识别发热婴儿的细菌感染方面具有高敏感性，但特异性相对较低。与白细胞计数等传统实验室检查相比，C反应蛋白和降钙素原等更新的实验室检查具有良好的检测特性。由于缺乏大量前瞻性收集的数据、定义阳性的阈值不同以及各研究的纳入标准不同，这些新型生物标志物尚未得到广泛认可。然而，C反应蛋白和降钙素原在逐步评估过程中与其他患者特征相结合时，对严重细菌感染的检测具有高敏感性。RNA生物标志物是一种正在研究的用于检测发热婴儿细菌感染的新型生物标志物。
