The researchers found that febrile infants may not need pain tests, antibiotics, or hospitalizations

A national research team led by clinicians and researchers from UC Davis Health at the University of Michigan, Nationwide Children's Hospital and Columbia University, has developed and validated a new protocol for stroke services. urgency to determine infants with fever aged 60 days or less, are at low risk of significant bacterial infections.

The discovery has important implications for the identification of cases in which infants may not need invasive medical care such as spinal taps, antibiotics or hospitalizations.

The large study, which involved nearly 2,000 febrile infants badessed in 26 emergency departments across the country, showed how doctors can more accurately identify infants at low risk of serious bacterial infections such as urinary tract infections, blood bacteria and bacteria. meningitis, to avoid lumbar puncture (also known as lumbar punctures), antibiotics and hospitalizations, which also involve risks and can be expensive.

The study, "A Clinical Prediction Rule to Identify Febrile Infants of 60 Days and Under Exposed to a Low Risk of Severe Bacterial Infection", is online today. [Embargoed until Mon., Feb. 18, 2019 at 11 a.m. ET] in JAMA Pediatrics.

The new protocol, which could be implemented as a result of a broader validation study, would improve the decision-making of emergency service providers and relieve the parents of many of the nearly 500,000 febrile infants evaluated annually in the United States Emergency Services.

"The absence of a serious bacterial infection in an infant can lead to serious complications, which is why doctors have always been very cautious and have included invasive procedures, medications, and hospitalizations when they are treated. evaluation of these infants, "said Nathan Kuppermann, professor and chair of emergency medicine at the UC. Davis School of Medicine and lead author of the study. "We have been able to establish and validate a prediction rule, essentially a mathematical tool that allows physicians to make confident clinical decisions about young infants with fever to identify those with low risk of developing". serious bacterial infections. "

In the United States, less than 10% of infants diagnosed with fever in emergency departments generally have serious or even life-threatening bacterial infections. However, because of their age and standard treatment guidelines, many must undergo invasive testing, be hospitalized and receive antibiotic treatment until a bacterial infection can be ruled out.

Kuppermann and colleagues in the Pediatric Emergency Care Applied Research Network (PECARN), a pediatric emergency service network across the country, are working to establish new, evidence-based standards for problem management important and common in pediatric emergency care. work to develop better approaches to identify febrile babies at low risk of serious bacterial infection. Two years ago, the same research consortium established a proof of principle for measuring the expression patterns of ribonucleic acid (RNA) in the blood allowing clinicians to distinguish bacterial infections from others. causes.

Now, in this large multicenter study, 1,821 infants with fevers less than two months (60 days) were enrolled and randomly divided into two groups. Using sophisticated statistical methods, the research team identified three easily obtainable laboratory tests: urine badysis, the absolute number of neutrophils (ANC) in the blood and a serum procalcitonin, to evaluate and validate the rule that doctors could use to rule out serious bacterial infections with very high accuracy. .

"Our data is important information in the decades-long debate about the need for lumbar punctures and hospitalizations of young infants with fever," said Prashant Mahajan, professor and vice president of medicine. 39 Emergency at the University of Michigan Medical School and at the CS Mott Children's Hospital. and the main author of the study. "This study adds important information that we believe will reduce the variability of current protocols and minimize unnecessary testing and hospitalizations, which may include other risks for young patients."

While their findings are encouraging, the researchers noted that it was important to continue validation before the new rule was fully implemented, particularly among cohorts with more invasive bacterial infections.

"Clinicians need to remain especially cautious in cases where infants are less than 28 days old," said Octavio Ramilo, head of the division of infectious diseases at the National Children's Hospital and principal investigator of the study. with Kuppermann and Mahajan. "This is the age group in which the risks of bacteremia and bacterial meningitis, as well as herpes encephalitis, are the most important."

In addition to Kuppermann, Mahajan and Ramilo, researchers included Peter Dayan from Columbia University and nearly two dozen other coauthors from the pediatric research network.

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