From the Division of Emergency Medicine, Ann and Robert H. Lurie Children's Hospital of Chicago & Department of Pediatrics, Northwestern University Feinberg School of Medicine, Chicago, IL.
Division of Pediatric Infectious Diseases and Center for Vaccines and Immunity, Nationwide Children's Hospital and The Ohio State University, Columbus, OH.
Pediatr Emerg Care. 2021 May 1;37(5):e221-e226. doi: 10.1097/PEC.0000000000002187.
Few prospective studies have assessed the occurrence of radiographic pneumonia in young febrile infants. We analyzed factors associated with radiographic pneumonias in febrile infants 60 days or younger evaluated in pediatric emergency departments.
We conducted a planned secondary analysis of a prospective cohort study within 26 emergency departments in a pediatric research network from 2008 to 2013. Febrile (≥38°C) infants 60 days or younger who received chest radiographs were included. Chest radiograph reports were categorized as "no," "possible," or "definite" pneumonia. We compared demographics, Yale Observation Scale scores (>10 implying ill appearance), laboratory markers, blood cultures, and viral testing among groups.
Of 4778 infants, 1724 (36.1%) had chest radiographs performed; 2.7% (n = 46) had definite pneumonias, and 3.9% (n = 67) had possible pneumonias. Patients with definite (13/46 [28.3%]) or possible (15/67 [22.7%]) pneumonias more frequently had Yale Observation Scale score >10 compared with those without pneumonias (210/1611 [13.2%], P = 0.002) in univariable and multivariable analyses. Median white blood cell count (WBC), absolute neutrophil count (ANC), and procalcitonin (PCT) were higher in the definite (WBC, 11.5 [interquartile range, 9.8-15.5]; ANC, 5.0 [3.2-7.6]; PCT, 0.4 [0.2-2.1]) versus no pneumonia (WBC, 10.0 [7.6-13.3]; ANC, 3.4 [2.1-5.4]; PCT, 0.2 [0.2-0.3]; WBC, P = 0.006; ANC, P = 0.002; PCT, P = 0.046) groups, but of unclear clinical significance. There were no cases of bacteremia in the definite pneumonia group. Viral infections were more frequent in groups with definite (25/38 [65.8%]) and possible (28/55 [50.9%]) pneumonias than no pneumonias (534/1185 [45.1%], P = 0.02).
Radiographic pneumonias were uncommon, often had viruses detected, and were associated with ill appearance, but few other predictors, in febrile infants 60 days or younger.
很少有前瞻性研究评估发热婴儿的放射学肺炎的发生情况。我们分析了在儿科急诊部门评估的 60 天或更小的发热婴儿中放射学肺炎的相关因素。
我们对 2008 年至 2013 年期间儿科研究网络中的 26 个急诊部门进行了一项前瞻性队列研究的计划二次分析。纳入了发热（≥38°C）且年龄在 60 天或以下接受胸部 X 光检查的婴儿。胸部 X 光报告分为“无”、“可能”或“明确”肺炎。我们比较了各组之间的人口统计学、耶鲁观察量表评分（>10 表示外观不佳）、实验室标志物、血培养和病毒检测。
在 4778 名婴儿中，有 1724 名（36.1%）进行了胸部 X 光检查；2.7%（n=46）有明确的肺炎，3.9%（n=67）有可能的肺炎。与无肺炎的婴儿相比，患有明确（13/46 [28.3%]）或可能（15/67 [22.7%]）肺炎的婴儿更常出现耶鲁观察量表评分>10（210/1611 [13.2%]，P=0.002），无论是在单变量还是多变量分析中。明确（白细胞计数[WBC]，11.5 [四分位距，9.8-15.5]；绝对中性粒细胞计数[ANC]，5.0 [3.2-7.6]；降钙素原[PCT]，0.4 [0.2-2.1]）与无肺炎组（WBC，10.0 [7.6-13.3]；ANC，3.4 [2.1-5.4]；PCT，0.2 [0.2-0.3]；WBC，P=0.006；ANC，P=0.002；PCT，P=0.046）相比，白细胞计数（WBC）、绝对中性粒细胞计数（ANC）和降钙素原（PCT）更高，但临床意义不明确。在明确的肺炎组中没有菌血症病例。明确（25/38 [65.8%]）和可能（28/55 [50.9%]）肺炎组的病毒感染发生率高于无肺炎组（534/1185 [45.1%]，P=0.02）。
发热 60 天或以下的婴儿中，放射学肺炎不常见，常伴有病毒感染，且与外观不佳有关，但很少有其他预测因素。
