Department of Pediatrics, Ann and Robert H Lurie Children's Hospital of Chicago, Chicago, Illinois, USA
Pediatrics, Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA.
Emerg Med J. 2023 Dec 22;41(1):13-19. doi: 10.1136/emermed-2023-213089.
The lack of evidence-based criteria to guide chest radiograph (CXR) use in young febrile infants results in variation in its use with resultant suboptimal quality of care. We sought to describe the features associated with radiographic pneumonias in young febrile infants.
Secondary analysis of a prospective cohort study in 18 emergency departments (EDs) in the Pediatric Emergency Care Applied Research Network from 2016 to 2019. Febrile (≥38°C) infants aged ≤60 days who received CXRs were included. CXR reports were categorised as 'no', 'possible' or 'definite' pneumonia. We compared demographics, clinical signs and laboratory tests among infants with and without pneumonias.
Of 2612 infants, 568 (21.7%) had CXRs performed; 19 (3.3%) had definite and 34 (6%) had possible pneumonias. Patients with definite (4/19, 21.1%) or possible (11/34, 32.4%) pneumonias more frequently presented with respiratory distress compared with those without (77/515, 15.0%) pneumonias (adjusted OR 2.17; 95% CI 1.04 to 4.51). There were no differences in temperature or HR in infants with and without radiographic pneumonias. The median serum procalcitonin (PCT) level was higher in the definite (0.7 ng/mL (IQR 0.1, 1.5)) vs no pneumonia (0.1 ng/mL (IQR 0.1, 0.3)) groups, as was the median absolute neutrophil count (ANC) (definite, 5.8 K/mcL (IQR 3.9, 6.9) vs no pneumonia, 3.1 K/mcL (IQR 1.9, 5.3)). No infants with pneumonia had bacteraemia. Viral detection was frequent (no pneumonia (309/422, 73.2%), definite pneumonia (11/16, 68.8%), possible pneumonia (25/29, 86.2%)). Respiratory syncytial virus was the predominant pathogen in the pneumonia groups and rhinovirus in infants without pneumonias.
Radiographic pneumonias were uncommon in febrile infants. Viral detection was common. Pneumonia was associated with respiratory distress, but few other factors. Although ANC and PCT levels were elevated in infants with definite pneumonias, further work is necessary to evaluate the role of blood biomarkers in infant pneumonias.
缺乏循证标准来指导发热婴儿的胸部 X 光（CXR）使用，导致其使用存在差异，从而导致护理质量不理想。我们旨在描述发热婴儿中与放射学肺炎相关的特征。
这是 2016 年至 2019 年期间儿科急诊护理应用研究网络（PECARN）18 个急诊部（ED）的前瞻性队列研究的二次分析。纳入发热（≥38°C）且年龄≤60 天、接受 CXR 的婴儿。CXR 报告分为“无”、“可能”或“明确”肺炎。我们比较了有和无肺炎婴儿的人口统计学、临床体征和实验室检查结果。
在 2612 名婴儿中，有 568 名（21.7%）进行了 CXR 检查；19 名（3.3%）有明确肺炎，34 名（6%）有可能肺炎。与无肺炎（77/515，15.0%）相比，有明确（4/19，21.1%）或可能（11/34，32.4%）肺炎的患者更常出现呼吸窘迫（校正 OR 2.17；95%CI 1.04 至 4.51）。有和无放射学肺炎的婴儿的体温或心率无差异。明确肺炎（0.7ng/ml（IQR 0.1，1.5））与无肺炎（0.1ng/ml（IQR 0.1，0.3））组相比，血清降钙素原（PCT）水平中位数更高，绝对中性粒细胞计数（ANC）也更高（明确肺炎，5.8K/mcL（IQR 3.9，6.9） vs 无肺炎，3.1K/mcL（IQR 1.9，5.3））。无肺炎婴儿无菌血症。病毒检测常见（无肺炎（309/422，73.2%），明确肺炎（11/16，68.8%），可能肺炎（25/29，86.2%））。肺炎组以呼吸道合胞病毒为主，无肺炎组以鼻病毒为主。
发热婴儿的放射学肺炎并不常见。病毒检测常见。肺炎与呼吸窘迫相关，但其他因素较少。虽然明确肺炎婴儿的 ANC 和 PCT 水平升高，但仍需要进一步研究来评估血液生物标志物在婴儿肺炎中的作用。
