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Investigation of afebrile neonates with a history of fever

Published online by Cambridge University Press:  21 May 2015

Lance Brown ,
Tania Shaw ,
James A. Moynihan ,
T. Kent Denmark ,
Ameer Mody  and
William A. Wittlake
Lance Brown*
Affiliation:
Department of Emergency Medicine, Loma Linda University Medical Center and Children’s Hospital, Loma Linda, Calif
Tania Shaw
Affiliation:
Department of Emergency Medicine, Loma Linda University Medical Center and Children’s Hospital, Loma Linda, Calif
James A. Moynihan
Affiliation:
Department of Emergency Medicine, Loma Linda University Medical Center and Children’s Hospital, Loma Linda, Calif
T. Kent Denmark
Affiliation:
Department of Emergency Medicine, Loma Linda University Medical Center and Children’s Hospital, Loma Linda, Calif
Ameer Mody
Affiliation:
Department of Emergency Medicine, Loma Linda University Medical Center and Children’s Hospital, Loma Linda, Calif
William A. Wittlake
Affiliation:
Department of Emergency Medicine, Loma Linda University Medical Center and Children’s Hospital, Loma Linda, Calif
*
Department of Emergency Medicine, A-108 Loma Linda University Medical Center and Children’s Hospital, 11234 Anderson St., Loma Linda CA 92354 USA; 909 558-4344, fax 909 558-0121, [email protected]

Abstract

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Objective:

Our objective was to describe clinically significant infections in a cohort of afebrile neonates who underwent an emergency department (ED) septic workup because of the history of a measured fever at home.

Methods:

Retrospective medical record review of all infants ≤28 days of age who presented to our tertiary care pediatric ED between Jan. 1, 1999, and Aug. 22, 2002, underwent lumbar puncture in the ED, had a reported temperature at home of ≥38°C, and an ED triage temperature of <38°C. Laboratory and radiographic results were tabulated.

Results:

During the study period, 206 neonates underwent lumbar puncture in our ED. Of these, 108 were excluded because their home temperature was not documented, and 71 were excluded because they were still febrile on presentation to the ED. The study group consisted of the remaining 27 subjects, 4 of whom had received acetaminophen prior to ED arrival. Infections were confirmed in 10 (37%) subjects (3 urinary tract infections, 2 aseptic meningitis, 1 enterovirus meningitis, 1 respiratory syncytial virus bronchiolitis, 1 rotavirus enteritis and 2 pneumonias).

Conclusions:

Clinically important infections are not uncommon among afebrile neonates undergoing ED septic workup because of a measured fever at home. Some diagnostic testing is warranted in this group, although the clinical utility and indications for specific test modalities remain unclear.

Keywords

sepsisoccultmeningitispyelonephritisvirus
Type
Pediatric EM • Pédiatrie d’urgence
Information
Canadian Journal of Emergency Medicine , Volume 6 , Issue 5 , September 2004 , pp. 343 - 348
Copyright
Copyright © Canadian Association of Emergency Physicians 2004

References

1.Baraff, LJ, Bass, JW, Fleisher, GR, Klein, JO, McCracken, GH, et al. Practice guideline for the management of infants and children 0 to 36 months of age with fever without source. Pediatrics 1993;92:1–12.Google Scholar
2.American College of Emergency Physicians Clinical Policies Committee and the Clinical Policies Subcommittee on Pediatric Fever. Clinical policy for children younger than three years presenting to the ED with fever. Ann Emerg Med 2003;42;530–45.Google Scholar
3.Steere, M, Sharieff, GQ, Stenklyft, PH.Fever in children less than 36 months of age — questions and strategies for management in the emergency department. J Emerg Med 2003;25:149–57.Google Scholar
4.Baker, MD, Bell, LM.Unpredictability of serious bacterial illness in febrile infants from birth to 1 month of age. Arch Pediatr Adolesc Med 1999;153:508–11.CrossRefGoogle ScholarPubMed
5.Kadish, HA, Loveridge, B, Tobey, J, Bolte, RG, Corneli, HM.Applying outpatient protocols in febrile infants 1–28 days of age: Can the threshold be lowered? Clin Pediatr 2000;39:81–8.Google Scholar
6.Chiu, CH, Lin, TY, Bullard, MJ.Application of criteria identifying febrile outpatient neonates at low risk for bacterial infections. Pediatr Infect Dis J 1994;13:946–9.CrossRefGoogle ScholarPubMed
7.Ferrera, PC, Bartfield, JM, Snyder, HS.Neonatal fever: utility of the Rochester criteria in determining low risk for serious bacterial infections. Am J Emerg Med 1997;15:299–302.Google Scholar
8.Chiu, CH, Lin, TY, Bullard, MJ.Identification of febrile neonates unlikely to have bacterial infections. Pediatr Infect Dis J 1997;16:59–63.Google Scholar
9.Bonadio, WA.Incidence of serious infections in afebrile neonates with a history of fever. Pediatr Infect Dis J 1987;6:911–4.Google Scholar
10.DeAngelis, C, Joffe, A, Willis, E, Wilson, M.Hospitalization v. outpatient treatment of young, febrile infants. Am J Dis Child 1983;137:1150–2.Google Scholar
11.Gilbert, EH, Lowenstein, SR, Koziol-McLain, J, Barta, DC, Steiner, J.Chart reviews in emergency medicine research: Where are the methods? Ann Emerg Med 1996;27:305–8.Google Scholar
12.Jovanovic, BD, Zalenski, RJ.Safety evaluation and confidence intervals when the number of observed events is small or zero. Ann Emerg Med 1997;30:301–6.Google Scholar
13.Young, KD, Lewis, RJ.What is confidence? Part 1: The use and interpretation of confidence intervals. Ann Emerg Med 1997;30:307–10.Google Scholar
14.Green, SM, Rothrock, SG.Evaluation styles for well-appearing febrile children: Are you a “risk minimizer” or a test-minimizer”? Ann Emerg Med 1999;33:211–4.Google Scholar
15.Mackie, PL, Joannidis, PA, Beattie, J.Evaluation of an acute point-of-care screening for respiratory syncytial virus infection. J Hosp Infect 2001;48:66–71.Google Scholar
16.Titus, MO, Wright, SW.Prevalence of serious bacterial infections in febrile infants with respiratory syncytial virus infection. Pediatrics 2003;112:282–4.CrossRefGoogle ScholarPubMed
17.Brown, L, Reiley, DG, Jeng, A, Green, SM.Bronchiolitis: Can objective criteria predict eligibility for brief hospitalization? Can J Emerg Med 2003;5(4):239–44.Google Scholar
18.Bonner, AB, Monroe, KW, Talley, LI, Klasner, AE, Kimberlin, DW.Impact of the rapid diagnosis of influenza on physician decision-making and patient management in the pediatric emergency department: Results of a randomized, prospective, controlled trial. Pediatrics 2003;112:363–7.Google Scholar
19.Zbinden, R, Kunz, J, Schaad, UB, Slongo, R.Incidence and diagnosis of rotavirus infection in neonates: results of two studies. J Perinat Med 1990;18:363–8.Google Scholar
20.Lipson, SM, Svenssen, L, Goodwin, L, Porti, D, Danzi, S, Pergolizzi, R.Evaluation of two current generation enzyme immunoassays and an improved isolation-based assay for the rapid detection and isolation of rotavirus from stool. J Clin Virol 2001;21:17–27.Google Scholar
21.Kimberlin, DW, Lin, CY, Jacobs, RF, Powell, DA, Frenkel, LM, Gruber, WC, et al. Natural history of neonatal herpes simplex virus infections in the acyclovir era. Pediatrics 2001;108:223–9.CrossRefGoogle ScholarPubMed
22.Filippine, MM, Katz, BZ.Neonatal herpes simplex virus infection presenting with fever alone. J Hum Virol 2001;4:223–5.Google ScholarPubMed
23.Hall, CB, Kopelman, AE, Douglas, RG Jr, Geiman, JM, Meagher, MP.Neonatal respiratory syncytial virus infection. N Engl J Med 1979;300:393–6.Google Scholar
24.Kimberlin, DW, Lin, CY, Jacobs, RF, Powell, DA, Corey, L, Gruber, WC, et al. Safety and efficacy of high-dose intravenous acyclovir in the management of neonatal herpes simplex virus infections. Pediatrics 2001;108:230–8.Google Scholar
25.Graneto, JW, Soglin, DF.Maternal screening of childhood fever by palpation. Pediatr Emerg Care 1996;12:183–4.Google Scholar