Divisions of Pediatric Emergency Medicine and
Infectious Disease, Department of Pediatrics, UPMC Children's Hospital of Pittsburgh, School of Medicine, University of Pittsburgh, Pittsburgh, Pennsylvania.
Pediatrics. 2019 Aug;144(2). doi: 10.1542/peds.2018-3964.
Infants ≤28 days of age with fever are frequently hospitalized while undergoing infectious evaluation. We assessed differences in rates of serious bacterial infection (SBI; bacteremia, bacterial meningitis, urinary tract infection) and invasive bacterial infection (IBI; bacteremia, bacterial meningitis) among the following neonates: (1) febrile at presentation (FP), (2) afebrile with history of fever without subsequent fever during hospitalization, and (3) afebrile with history of fever with subsequent fever during hospitalization.
We performed a single-center retrospective study of neonates evaluated for SBI during emergency department evaluation between January 1, 2006, and December 31, 2017. Patients were categorized into FP, afebrile with no subsequent fever (ANF), and afebrile with subsequent fever (ASF) groups. We compared rates of SBI and IBI between groups using logistic regression and assessed time to fever development using time-to-event analysis.
Of 931 neonates, 278 (29.9%) were in the ANF group, 93 (10.0%) were in the ASF group, and 560 (60.2%) were in the FP group. Odds of SBI in neonates ANF were 0.42 (95% confidence interval [CI] 0.23-0.79) compared with infants FP, although differences in IBI were not statistically significant (0.52, 95% CI 0.19-1.51). In infants ASF, median time to fever was 5.6 hours (interquartile range, 3.1-11.4). Infants ASF had higher odds of SBI compared to infants FP (odds ratio 1.93, 95% CI 1.07-3.50).
Neonates with history of fever who remain afebrile during hospitalization may have lower odds for SBI and be candidates for early discharge after an observation period.
≤28 天龄的发热婴儿在接受感染评估时常需住院。我们评估了以下新生儿中严重细菌性感染（SBI；菌血症、细菌性脑膜炎、尿路感染）和侵袭性细菌性感染（IBI；菌血症、细菌性脑膜炎）的发生率差异：（1）发热时就诊（FP），（2）无热但有发热史且住院期间无后续发热，（3）无热但有发热史且住院期间有后续发热。
我们对 2006 年 1 月 1 日至 2017 年 12 月 31 日期间因 SBI 接受急诊评估的新生儿进行了一项单中心回顾性研究。患者分为 FP、无热但无后续发热（ANF）和无热但有后续发热（ASF）组。我们使用逻辑回归比较了各组间 SBI 和 IBI 的发生率，并使用生存时间分析评估了发热发展的时间。
在 931 名新生儿中，278 名（29.9%）为 ANF 组，93 名（10.0%）为 ASF 组，560 名（60.2%）为 FP 组。与 FP 组相比，ANF 新生儿发生 SBI 的几率为 0.42（95%置信区间[CI]0.23-0.79），而 IBI 差异无统计学意义（0.52，95%CI0.19-1.51）。在 ASF 新生儿中，发热中位时间为 5.6 小时（四分位间距 3.1-11.4）。与 FP 组相比，ASF 组新生儿 SBI 的几率更高（比值比 1.93，95%CI1.07-3.50）。
住院期间有发热史但无热的新生儿发生 SBI 的可能性较低，在观察期后可作为提前出院的候选者。
