State University of New York Downstate Medical Center, Brooklyn, New York; Kings County Hospital New York Health and Hospitals, Brooklyn, New York.
J Emerg Med. 2022 Aug;63(2):159-168. doi: 10.1016/j.jemermed.2021.10.003. Epub 2022 Jun 9.
Febrile neonates undergo lumbar puncture (LP), empiric antibiotic administration, and admission for increased risk of invasive bacterial infection (IBI), defined as bacteremia and meningitis.
Measure IBI prevalence in febrile neonates, and operating characteristics of Rochester Criteria (RC), Yale Observation Scale (YOS) score, and demographics as a low-risk screening tool.
Secondary analysis of healthy febrile infants < 60 days old presenting to any of 26 emergency departments in the Pediatric Emergency Care Applied Research Network between December 2008 and May 2013. Of 7334 infants, 1524 met our inclusion criteria of age ≤ 28 days. All had fevers and underwent evaluation for IBI. Receiver operator characteristic (ROC) curve and transparent decision tree analysis were used to determine the applicability of reassuring RC, YOS, and age parameters as an IBI low-risk screening tool.
Of 1524 neonates, 2.9% had bacteremia and 1.5% had meningitis. After applying RC and YOS, 15 neonates were incorrectly identified as low risk for IBI (10 bacteremia, 4 meningitis, 1 bacteremia, and meningitis). Age ≤ 18 days was a statistically significant variable ROC (area under curve 0.63, p < 0.05). Incorporating age > 18 days as low-risk criteria with reassuring RC and YOS misclassified 7 IBI patients (6 bacteremia, 1 meningitis).
Thirty percent of febrile neonates met low-risk criteria, age > 18 days, reassuring RC and YOS, and could avoid LP and empiric antibiotics. Our low-risk guidelines may improve patient safety and reduce health care costs by decreasing lab testing for cerebrospinal fluid, empiric antibiotic administration, and prolonged hospitalization. These results are hypothesis-generating and should be verified with a randomized prospective study.
发热的新生儿会接受腰椎穿刺（LP）、经验性抗生素治疗，并因侵袭性细菌感染（IBI）的风险增加而住院，IBI 的定义为菌血症和脑膜炎。
测量发热新生儿的 IBI 患病率，以及罗切斯特标准（RC）、耶鲁观察量表（YOS）评分和人口统计学作为低风险筛查工具的操作特征。
对 2008 年 12 月至 2013 年 5 月期间在儿科急诊护理应用研究网络的 26 个急诊部门就诊的年龄<60 天的健康发热婴儿进行二次分析。在 7334 名婴儿中，有 1524 名符合我们的纳入标准，即年龄≤28 天。所有婴儿均有发热，并接受了 IBI 评估。采用受试者工作特征（ROC）曲线和透明决策树分析来确定令人放心的 RC、YOS 和年龄参数作为 IBI 低风险筛查工具的适用性。
在 1524 名新生儿中，2.9%患有菌血症，1.5%患有脑膜炎。应用 RC 和 YOS 后，有 15 名婴儿被错误地确定为 IBI 低风险（10 名菌血症，4 名脑膜炎，1 名菌血症和脑膜炎）。年龄≤18 天是一个具有统计学意义的 ROC 变量（曲线下面积 0.63，p<0.05）。将年龄>18 天作为低风险标准，结合令人放心的 RC 和 YOS，会错误地分类 7 名 IBI 患者（6 名菌血症，1 名脑膜炎）。
30%的发热新生儿符合低风险标准，年龄>18 天，令人放心的 RC 和 YOS，可以避免 LP 和经验性抗生素治疗。我们的低风险指南可以通过减少脑脊液实验室检查、经验性抗生素治疗和延长住院时间来提高患者安全性并降低医疗成本。这些结果是产生假说的，并应通过随机前瞻性研究进行验证。
