High Variability in Management of Fever in Young Infants

Louis M. Bell, MD

Pediatric emergency department care for fever in infants aged <90 days — a sign of possible serious bacterial infection — differed greatly across U.S. institutions.

Because of an elevated risk for serious bacterial infection, febrile young infants often undergo diagnostic testing of the urine, blood, and cerebral spinal fluid to rule out infection. Although practice guidelines exist, variable approaches to testing and managing these patients have been documented.

Using a national administrative database, researchers retrospectively assessed variation in care of >35,000 febrile infants aged <90 days who were evaluated in 37 children's hospital emergency departments between 2011 and 2013. Results were analyzed across three age groups (≤28 days, 29–56 days, and 57–89 days).

Overall, younger infants were more likely to undergo urine, blood, and cerebral spinal fluid testing (age ≤28 days, 72%; 29–56 days, 49%; 57–89 days, 13%). Admission rates also decreased with increasing age (78%, 44%, and 16%, respectively, for the youngest to the oldest age groups). The 3-day revisit rate was 6% for the >20,000 infants discharged from the emergency department.

Testing, treatment, and hospitalization varied widely by institution across all three age groups; however, the prevalence of serious bacterial infection and the 3-day revisit rate did not differ across institutions. The serious bacterial infection rate was 8.4% overall and was highest among infants aged ≤28 days (11.1%), peaking at 12.9% in the third week of life. Of the >35,000 febrile infants, 5.3% had urinary tract infections, 2.4% had bacteremia or sepsis, and 0.3% had meningitis. Twenty-two infants (0.06%) had herpes simplex virus infection.

Citation(s):

Aronson PL et al. Variation in care of the febrile young infant <90 days in US pediatric emergency departments. Pediatrics 2014 Oct; 134:667.