Pediatric Intensive Care Unit, Assaf Harofeh Medical Center, Zerifin, Israel.
Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel.
Eur J Pediatr. 2018 Mar;177(3):337-344. doi: 10.1007/s00431-018-3098-x. Epub 2018 Jan 31.
It is not clear if children with high fever are at increased risk for serious bacterial infection (SBI). Our aim was to systematically review if children suffering from high fever are at high risk for SBI. Our data sources were Embase, Medline, and Pubmed; from their inception until the last week of March 2017. The study selection were of cohort and case control studies comparing the incidence of SBI in children with hyperpyrexia with children with fever of 41 °C or less, and children with a temperature higher than 40 °C, with children with fever of 40 °C or less. Two reviewers independently pooled studies for detailed review using a structured data-collection form. We calculated the odds ratio and 95% confidence intervals (CI) for SBI, assuming a random-effects model. A sub-group analysis was conducted. In our results, 11 studies met the inclusion criteria. Two studies showed that children with hyperpyrexia are at higher risk for SBI (OR 1.96 95% CI 1.3-1.97). An increased risk for SBI in children with high fever (OR 3.21 95% CI 1.67; 6.22). SBI in infants with temperature over 40 °C was higher compared to infants with lower degree of fever (OR 6.3 95% CI 4.44; 8.95). On older children, the risk for SBI was only slightly higher in children with fever above 40 °C. The limitation of the study is the small amount of studies and that the heterogeneity of the studies was very high.
Young infants with temperature higher than 400 °C are at increased risk for SBI. Risk of SBI in older children with temperature > 400C is minimal. What is known: • An association between high fever and increased risk for SBI was reported in young infants. • Based on only two studies from the 1970s and 1980s, hyperpyrexia is associated with increased risk for SBI. What is new: • Infants under the age of 3 months with fever > 40 °C were found to have increased risk for SBI. • Risk of SBI in older children with temperature > 40 °C is minimal.
系统评价高热儿童是否存在严重细菌感染（SBI）风险增加。
Embase、Medline 和 Pubmed，从建立至 2017 年 3 月最后一周。
比较高热（体温＞41℃）儿童、高热（体温＞40℃）儿童与低热（体温＜40℃）儿童 SBI 发生率的队列研究和病例对照研究。两名评价员独立使用结构化数据采集表对研究进行详细评价。使用随机效应模型计算 SBI 的比值比（OR）和 95%置信区间（CI）。进行亚组分析。
11 项研究符合纳入标准。2 项研究表明高热儿童 SBI 风险较高（OR 1.96，95%CI 1.3-1.97），高热儿童 SBI 风险增加（OR 3.21，95%CI 1.67；6.22）。体温＞40℃的婴儿 SBI 发生率高于低程度发热婴儿（OR 6.3，95%CI 4.44；8.95）。年龄较大儿童中，体温＞40℃的儿童 SBI 风险仅略高。研究的局限性是研究数量少，研究异质性非常高。
体温＞40℃的小婴儿发生 SBI 的风险增加。体温＞40℃的大龄儿童发生 SBI 的风险很小。
• 高热与 SBI 风险增加之间存在相关性，这在小婴儿中已有报道。• 仅基于 20 世纪 70 年代和 80 年代的两项研究，高热与 SBI 风险增加相关。
• 年龄＜3 个月的发热＞40℃婴儿发生 SBI 的风险增加。• 体温＞40℃的大龄儿童发生 SBI 的风险很小。
