Fever in a neonate may be the only sign or symptom of a serious bacterial infection and it is known that these infants have an increased risk of serious bacterial infections. Due to these concerns, most of these infants with fever without a source undergo many invasive tests and are typically hospitalized. Over the last 20 years nucleic acid amplification tests such as PCR have been developed to help rapidly identify viral pathogens. This testing is more sensitive than traditionally used tests such as viral culture and DFA testing. Our objective was to determine the risk of serious bacterial infection in neonates with fever and an identified pathogen on a rapid respiratory viral panel PCR test or cerebral spinal fluid enterovirus PCR, which could potentially decrease testing and hospitalization.
We performed a retrospective chart review of the electronic medical record to identify all infants less than 60 days of age admitted to Alfred I. duPont Hospital for Children in Wilmington, Delaware from the emergency department from March 1, 2012 to December 31, 2014. The charts were reviewed to identify any infant admitted with fever or who underwent cultures of more than one sterile site. We reviewed the results of any microbiological studies, chest x-rays and rapid viral diagnostics and identified infants with bacterial infections and/or positive viral PCR.
We identified 463 individual encounters that met criteria. Viral PCRs were performed on 215 infants and 152 of these identified a viral etiology. There were 4 patients in this group of patients with an identified viral etiology who were also identified to have a serious bacterial infection (risk of SBI 2.6%). Overall there were 58 identified serious bacterial infections (risk of SBI 12.5%).
Neonatal fever is one of the most common diagnoses for hospitalization during infancy, which can be detrimental to the child and family and incurs significant cost. However only a small percentage of these patients have a serious bacterial infection requiring admission. In this study, there was a five-fold lower risk of serious bacterial infection in patients with an identified viral etiology on rapid PCR testing. With future high quality analysis and careful patient selection perhaps well-appearing patients with a positive viral target could avoid hospitalization.
M. Cellucci, None
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