Department of Pediatrics, Johns Hopkins Children's Center, Baltimore, Maryland.
Department of Pediatrics, University of Rochester Medical Center, Rochester, New York.
JAMA Netw Open. 2019 Mar 1;2(3):e190874. doi: 10.1001/jamanetworkopen.2019.0874.
Febrile neonates (persons in the first month of life) are believed to be at higher risk for bacteremia or bacterial meningitis than infants in their second month of life. However, the true prevalence is unclear.
To determine modern rates of bacteremia and bacterial meningitis in febrile neonates and infants in the second month of life presenting to an ambulatory setting.
A comprehensive, no-limit search was conducted in PubMed using previously published search terms in February 2015 and repeated in September 2016.
Abstracts and full texts were reviewed independently by several investigators. Studies were included if data regarding blood cultures or cerebrospinal fluid cultures from consecutive febrile infants in an ambulatory setting could be extrapolated within the age groups. To limit the analysis to the period after the availability of the Haemophilus influenzae type b vaccination, studies that collected data before 1990 were excluded.
Data were extracted in accordance with the Meta-analyses of Observational Studies in Epidemiology (MOOSE) reporting guidelines via independent abstraction by several investigators. The Newcastle-Ottawa Scale was used to assess bias.
The primary outcomes were prevalence rates of bacteremia and bacterial meningitis in febrile neonates and infants in the second month of life. In neonates, prevalence rates were also estimated in the era of group B Streptococcus intrapartum antibiotic prophylaxis (after 1996).
In total, 7264 abstracts were screened, resulting in 188 full-text manuscripts reviewed, with 12 meeting inclusion criteria (with 15 713 culture results). For febrile neonates, the prevalence of bacteremia was 2.9% (95% CI, 2.3%-3.7%; I2 = 50%; n = 5145) and the prevalence of bacterial meningitis was 1.2% (95% CI, 0.8%-1.9%; I2 = 27%; n = 3288). In neonates in the era after group B Streptococcus prophylaxis, the prevalence of bacteremia was 3.0% (95% CI, 2.3%-3.9%; I2 = 6%; n = 2055) and the prevalence of meningitis was 1.0% (95% CI, 0.4%-2.1%; I2 = 28%; n = 1739). For febrile infants in the second month of life, the prevalence of bacteremia was 1.6% (95% CI, 0.9%-2.7%; I2 = 78%; n = 4778) and the prevalence of meningitis was 0.4% (95% CI, 0.2%-1.0%; I2 = 33%; n = 2502).
These findings suggest that febrile neonates have approximately twice the rate of bacteremia and meningitis as febrile infants in their second month of life.
与出生后第二个月的婴儿相比，发热的新生儿（生命的第一个月的人）被认为有更高的菌血症或细菌性脑膜炎风险。然而，真实的患病率尚不清楚。
确定发热的新生儿和第二个月的婴儿在门诊就诊时菌血症和细菌性脑膜炎的现代发病率。
2015 年 2 月，使用先前发表的搜索词在 PubMed 中进行了全面、无限制的搜索，并于 2016 年 9 月重复搜索。
由几位研究人员独立审查摘要和全文。如果可以从门诊连续发热婴儿中推断出数据，则将纳入研究血培养或脑脊液培养的数据。为了将分析限制在乙型流感嗜血杆菌疫苗可用之后的时期，排除了收集 1990 年前数据的研究。
几位研究人员按照观察性研究荟萃分析（MOOSE）报告指南独立提取数据。使用纽卡斯尔-渥太华量表评估偏倚。
主要结局是发热的新生儿和第二个月的婴儿的菌血症和细菌性脑膜炎的患病率。在新生儿中，还估计了 B 组链球菌产时抗生素预防（1996 年后）时代的患病率。
共筛选了 7264 篇摘要，最终审查了 188 篇全文，其中 12 篇符合纳入标准（共 15713 项培养结果）。对于发热的新生儿，菌血症的患病率为 2.9%（95%CI，2.3%-3.7%；I2=50%；n=5145），细菌性脑膜炎的患病率为 1.2%（95%CI，0.8%-1.9%；I2=27%；n=3288）。在 B 组链球菌预防后时代的新生儿中，菌血症的患病率为 3.0%（95%CI，2.3%-3.9%；I2=6%；n=2055），脑膜炎的患病率为 1.0%（95%CI，0.4%-2.1%；I2=28%；n=1739）。对于第二个月的发热婴儿，菌血症的患病率为 1.6%（95%CI，0.9%-2.7%；I2=78%；n=4778），脑膜炎的患病率为 0.4%（95%CI，0.2%-1.0%；I2=33%；n=2502）。
这些发现表明，发热的新生儿的菌血症和脑膜炎发生率约为第二个月发热婴儿的两倍。
