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American Academy of Pediatrics
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Characteristics of Afebrile Infants ≤60 Days of Age With Invasive Bacterial Infections

Marie E. Wang, Mark I. Neuman, Lise E. Nigrovic, Christopher M. Pruitt, Sanyukta Desai, Adrienne G. DePorre, Laura F. Sartori, Richard D. Marble, Christopher Woll, Rianna C. Leazer, Fran Balamuth, Sahar N. Rooholamini and Paul L. Aronson; ON BEHALF OF THE FEBRILE YOUNG INFANT RESEARCH COLLABORATIVE
Hospital Pediatrics January 2021, 11 (1) 100-105; DOI: https://doi.org/10.1542/hpeds.2020-002204
Marie E. Wang
aDivision of Pediatric Hospital Medicine, Department of Pediatrics, Lucile Packard Children’s Hospital Stanford and School of Medicine, Stanford University, Palo Alto, California;
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Mark I. Neuman
bDivision of Emergency Medicine, Boston Children’s Hospital and Harvard Medical School, Harvard University, Boston, Massachusetts;
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Lise E. Nigrovic
bDivision of Emergency Medicine, Boston Children’s Hospital and Harvard Medical School, Harvard University, Boston, Massachusetts;
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Christopher M. Pruitt
cDivision of Pediatric Emergency Medicine, Department of Pediatrics, University of Alabama at Birmingham, Birmingham, Alabama;
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Sanyukta Desai
dDivision of Hospital Medicine, Department of Pediatrics, Cincinnati Children’s Hospital Medical Center and College of Medicine, University of Cincinnati, Cincinnati, Ohio;
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Adrienne G. DePorre
eDivision of Hospital Medicine, Department of Pediatrics, Children’s Mercy Hospital, Kansas City, Missouri;
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Laura F. Sartori
fDivision of Pediatric Emergency Medicine, Department of Pediatrics, Monroe Carell Jr Children’s Hospital at Vanderbilt and School of Medicine, Vanderbilt University, Nashville, Tennessee;
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Richard D. Marble
gDivision of Emergency Medicine, Ann and Robert H. Lurie Children’s Hospital of Chicago and Feinberg School of Medicine, Northwestern University, Chicago, Illinois;
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Christopher Woll
hSection of Pediatric Emergency Medicine, Departments of Pediatrics and of Emergency Medicine, Yale School of Medicine, Yale University, New Haven, Connecticut;
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Rianna C. Leazer
iDivision of Hospital Medicine, Department of Pediatrics, Children’s Hospital of The King’s Daughters, Norfolk, Virginia;
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Fran Balamuth
jDivision of Emergency Medicine and Center for Pediatric Clinical Effectiveness, Department of Pediatrics, Children’s Hospital of Philadelphia and Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania; and
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Sahar N. Rooholamini
kDivision of Hospital Medicine, Department of Pediatrics, Seattle Children’s Hospital and School of Medicine, University of Washington, Seattle, Washington
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Paul L. Aronson
hSection of Pediatric Emergency Medicine, Departments of Pediatrics and of Emergency Medicine, Yale School of Medicine, Yale University, New Haven, Connecticut;
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Abstract

OBJECTIVES: To describe the characteristics and outcomes of afebrile infants ≤60 days old with invasive bacterial infection (IBI).

METHODS: We conducted a secondary analysis of a cross-sectional study of infants ≤60 days old with IBI presenting to the emergency departments (EDs) of 11 children’s hospitals from 2011 to 2016. We classified infants as afebrile if there was absence of a temperature ≥38°C at home, at the referring clinic, or in the ED. Bacteremia and bacterial meningitis were defined as pathogenic bacterial growth from a blood and/or cerebrospinal fluid culture.

RESULTS: Of 440 infants with IBI, 78 (18%) were afebrile. Among afebrile infants, 62 (79%) had bacteremia without meningitis and 16 (20%) had bacterial meningitis (10 with concomitant bacteremia). Five infants (6%) died, all with bacteremia. The most common pathogens were Streptococcus agalactiae (35%), Escherichia coli (16%), and Staphylococcus aureus (16%). Sixty infants (77%) had an abnormal triage vital sign (temperature <36°C, heart rate ≥181 beats per minute, or respiratory rate ≥66 breaths per minute) or a physical examination abnormality (ill appearance, full or depressed fontanelle, increased work of breathing, or signs of focal infection). Forty-three infants (55%) had ≥1 of the following laboratory abnormalities: white blood cell count <5000 or >15 000 cells per μL, absolute band count >1500 cells per μl, or positive urinalysis. Presence of an abnormal vital sign, examination finding, or laboratory test result had a sensitivity of 91% (95% confidence interval 82%–96%) for IBI.

CONCLUSIONS: Most afebrile young infants with an IBI had vital sign, examination, or laboratory abnormalities. Future studies should evaluate the predictive ability of these criteria in afebrile infants undergoing evaluation for IBI.

  • Copyright © 2021 by the American Academy of Pediatrics
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Hospital Pediatrics: 11 (1)
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Characteristics of Afebrile Infants ≤60 Days of Age With Invasive Bacterial Infections
Marie E. Wang, Mark I. Neuman, Lise E. Nigrovic, Christopher M. Pruitt, Sanyukta Desai, Adrienne G. DePorre, Laura F. Sartori, Richard D. Marble, Christopher Woll, Rianna C. Leazer, Fran Balamuth, Sahar N. Rooholamini, Paul L. Aronson
Hospital Pediatrics Jan 2021, 11 (1) 100-105; DOI: 10.1542/hpeds.2020-002204

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Characteristics of Afebrile Infants ≤60 Days of Age With Invasive Bacterial Infections
Marie E. Wang, Mark I. Neuman, Lise E. Nigrovic, Christopher M. Pruitt, Sanyukta Desai, Adrienne G. DePorre, Laura F. Sartori, Richard D. Marble, Christopher Woll, Rianna C. Leazer, Fran Balamuth, Sahar N. Rooholamini, Paul L. Aronson
Hospital Pediatrics Jan 2021, 11 (1) 100-105; DOI: 10.1542/hpeds.2020-002204
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