A search for the \"Holy Grail\" in the evaluation of febrile neonates aged 28 days or less: A prospective study
Dr. Efraim Bilavsky
1 slide(s) – English – 2010-10-23
Objective: To prospectively determine the reliability of low-risk criteria to exclude serious bacterial infection (SBI) in febrile neonates aged ?28 days.
Patients and methods: All febrile neonates aged ?28 days who were hospitalized for fever evaluation from 2005 to 2009 were prospectively divided into two groups by risk status for SBI. The following criteria were used to define low risk:
(1) unremarkable medical history;
(3) no focal signs of infection;
(4) white blood cell count between 5000 to 15000 /mm3;
(5) normal urinalysis;
(6) no mucoid or bloody diarrhea.
Findings were analyzed against the culture results, and routine validity measures and positive and negative likelihood ratios were calculated.
Results: Of the 465 neonates who met the inclusion criteria, 177 (38.1%) were considered at high risk for SBI and 288 (61.9%) low risk. On culture, SBIs were found in 55 (31.1%) neonates in the high-risk group compared to 10 (3.5%) in the low-risk group (p< 0.001). The sensitivity, specificity, positive predictive value and negative predictive value of the criteria for all types of SBI were 84.6% (95% CI - 73.9%-91.4%), 69.5% (95% CI 64.8%-73.8%), 31% (95% CI - 27.3%-35.1%) and 96.5% (95% CI - 94.3%-98%), respectively.
Conclusion: The defined criteria are a useful tool for predicting SBI in neonates. However, they are not sufficiently reliable to exclude an SBI or an invasive SBI. It is therefore suggested that all febrile neonates in this age group should be hospitalized for complete evaluation and consideration of empirical intravenous antibiotic treatment.