From the Department of Pediatrics, Children's Hospital of Philadelphia, Virtua Voorhees, Voorhees, NJ.
Department of Pediatrics, Children's Hospital of Philadelphia, Lancaster General Hospital, Lancaster, PA.
Pediatr Emerg Care. 2022 Jan 1;38(1):43-47. doi: 10.1097/PEC.0000000000002601.
A sepsis workup is recommended in young infants 56 days or younger with fever to rule out a serious bacterial infection (SBI). Given the reduction in non-severe acute respiratory syndrome - coronavirus 2 viral infections observed in multiple studies during the coronavirus diseases 2019 (COVID-19) pandemic, we sought to determine if the reduction in viral infections led to a change in the incidence of SBI in this vulnerable patient population.
We performed a multicenter, retrospective study of infants 56 days or younger presenting with fever to emergency departments of 6 community hospitals. We compared the incidence of SBIs, viral meningitis, and viral bronchiolitis during March 2020 to February 2021 (pandemic year) with the same calendar months in the 2 preceding years (prepandemic years).
From March 2018 to February 2021, 543 febrile infants presented to the emergency departments, 95 during the pandemic year (March 2020 to February 2021) compared with 231 and 217 in the prepandemic years (March 2018 to February 2019 and March 2019 to February 2020, respectively).During the pandemic year, 28.4% of infants (27 of 95) were diagnosed with an SBI compared with 11.7% and 6.9% (P < 0.001) in the prepandemic years (27 of 231 and 15 of 217, respectively). Five patients were diagnosed with bacterial meningitis over the 3-year period, 4 of them during the pandemic year (4 of 95 [4.2%]). Positivity for viral cerebrospinal fluid polymerase chain reaction during the pandemic year was 6.4% (3 of 47) compared with 20.8% (25 of 120) and 20.4% (23 of 113) in prepandemic years (P = 0.070). During the pandemic year, 2.1% (2 of 95) febrile young infants were admitted with a comorbid diagnosis of bronchiolitis compared with 4.3% and 6.0% in the prepandemic years (P = 0.310).
The COVID-19 pandemic led to an increase in the incidence of SBIs in febrile infants 56 days or younger, likely a result of reduction in non-severe acute respiratory syndrome - coronavirus 2 viral infections. Greater vigilance is thus warranted in the evaluation of febrile infants during the COVID-19 pandemic.
对于 56 天或更小的患有发热的婴儿，建议进行脓毒症检查，以排除严重细菌性感染（SBI）。鉴于在 2019 年冠状病毒病（COVID-19）大流行期间多项研究中观察到非严重急性呼吸综合征-冠状病毒 2 病毒感染减少，我们试图确定这种脆弱患者人群中病毒感染减少是否导致 SBI 的发生率发生变化。
我们对 6 家社区医院急诊科就诊的 56 天或更小的发热婴儿进行了一项多中心、回顾性研究。我们比较了 2020 年 3 月至 2021 年 2 月（大流行年）与前两年（大流行前）同期的 SBI、病毒性脑膜炎和病毒性细支气管炎的发生率。
从 2018 年 3 月至 2021 年 2 月，543 名发热婴儿到急诊科就诊，大流行年（2020 年 3 月至 2021 年 2 月）有 95 名，而大流行前年份（2018 年 3 月至 2019 年 2 月和 2019 年 3 月至 2020 年 2 月）分别为 231 名和 217 名。在大流行年期间，28.4%的婴儿（95 名中的 27 名）被诊断为 SBI，而在大流行前年份（231 名中的 27 名和 217 名中的 15 名）分别为 11.7%和 6.9%（P<0.001）。3 年内共诊断出 5 例细菌性脑膜炎患者，其中 4 例发生在大流行年（95 名中的 4 名[4.2%]）。大流行年期间，病毒性脑脊液聚合酶链反应阳性率为 6.4%（47 名中的 3 名），而大流行前年份分别为 20.8%（120 名中的 25 名）和 20.4%（113 名中的 23 名）（P=0.070）。在大流行年期间，2.1%（95 名中的 2 名）发热的年轻婴儿因合并细支气管炎而住院，而大流行前年份的这一比例为 4.3%和 6.0%（P=0.310）。
COVID-19 大流行导致 56 天或更小的发热婴儿 SBI 的发病率增加，可能是由于非严重急性呼吸综合征-冠状病毒 2 病毒感染减少所致。因此，在 COVID-19 大流行期间，对发热婴儿的评估需要更加警惕。
