Variation in management and outcomes of febrile infants

1. Great variation in management was seen among a cohort of febrile infants treated in the California Kaiser system.

2. Of the studied infants, 59% of those aged 7 to 28 days, 25% of infants aged 29 to 60 days, and 5% of infants aged 61 to 90 days underwent a full sepsis evaluation (i.e., urine, blood, and cerebrospinal fluid [CSF] cultures).

Evidence Rating Level: 2 (Good)

Study Rundown: The management of febrile young infants remains controversial, leading to significant variation in clinical practices. While some clinicians choose to do a full sepsis evaluation based on clinical suspicion, others prefer to watch and wait. Researchers used this investigation to describe the current clinical practice managing febrile infants and to explore outcomes of the studied infants. This study included a cohort aged 7 to 90 days between July 2010 and June 2013. Results showed that while a little more than half of the infants under one month of age had a full sepsis evaluation, this percentage decreased as age increased. In the 30-day period after discharge, a very low percentage of infants returned with a urinary tract infection and none had bacteremia or meningitis. This study was limited by variation in methods of measuring temperatures and the possibility of missing patients due to incorrect electronic medical record documentation. In addition, it is possible that this study may not be generalizable as only patients in the Northern California Kaiser system were included. While there is no clear consensus on the management of febrile infants, those included in this study had no delayed identification of bacteremia or meningitis. Pediatric care providers should be aware of these results when evaluating febrile infants and should continue to streamline this effort.

Click to read the study, published today in Pediatrics

Relevant Reading: Variation in care of the febrile young infant <90 days in US pediatric emergency departments

In-Depth [retrospective cohort]: Using data between June 2010 and July 2013 from Kaiser Permanente Northern California’s medical record, 1380 infants aged 7 to 90 days presented with fever to either a primary care or an emergency setting. This amounted to an incidence rate of 14.4 out of every 1000 full term infants (95%CI 13.6 – 15.1). Fever was defined was an axillary or rectal temperature greater than 38C. Among the febrile infants studied, 14% had an identified infectious source: 13.2% had a UTI, 2.6% had bacteremia, and 0.3% had meningitis. In addition, 1.8% had multiple infections identified. Among children aged 7 to 28 days, 18.8% of infections were identified, whereas 13.9% of infections were identified in infants aged 29 to 60 days, and 10.8% in infants aged 61 to 90 days. At least 1 blood culture was ordered for 68% infants. Infants evaluated in an emergency setting were 5 times more likely to have a culture drawn than infants evaluated in the primary care office setting (p < 0.0001). Among infants aged 7 to 28 days, 59% received a full sepsis evaluation, including urine, blood and CSF cultures, whereas only 25% of infants 29 to 60 days received a full evaluation, and 5% of infants aged 61 to 90 days underwent this complete evaluation. Almost 20% of infants received antibiotics within 14 days of presentation, which included 17% of infants with no bacterial cultures obtained. Within 30 days of the fever, 1% of infants came back with a UTI, but no infants returned with meningitis or bacteremia.

Image: CC/Wiki/Infantcentre

©2016 2 Minute Medicine, Inc. All rights reserved. No works may be reproduced without expressed written consent from 2 Minute Medicine, Inc. Inquire about licensing here. No article should be construed as medical advice and is not intended as such by the authors or by 2 Minute Medicine, Inc.