Is 15 days an appropriate cut-off age for considering serious bacterial infection in the management of febrile infants?
BACKGROUND
Febrile infants <3 months of age have a greater risk for serious bacterial infection (SBI). The risk is inversely correlated with age. Most protocols recommend admitting to hospital all febrile infants <28 days of age. However, as the prevalence of SBI is not homogenous in this age group, some authors have considered decreasing this cut-off age, allowing ambulatory management of selected patients meeting low-risk criteria.


OBJECTIVE
To determine whether 15 days is a suitable cut-off age for different approaches to the management of infants with fever.


METHODS
Cross-sectional descriptive study of infants <3 months of age with fever without a source seen between September 1, 2003 and August 30, 2010 in the pediatric emergency department of a tertiary teaching hospital. All infants <3 months of age with fever without a source (≤ 38 °C) were included. The following data were collected: age, sex, temperature, diagnosis, management in pediatric emergency department, and outcome.


RESULTS
Data were collected for 1575 infants; of whom, 311 (19.7%, 95% confidence intervals [CI]: 17.7-21.7) were found to have an SBI. The rate of SBI in the patients who were 15 to 21 days of age was 33.3% (95% CI: 23.7%-42.9%), similar to that among infants who were 7 to 14 days of age (31.9%, 95% CI: 21.1%-42.7%) and higher than among those older than 21 days of age (18.3%, 95% CI: 16.3-20.3%).


CONCLUSIONS
Febrile infants 15 to 21 days of age had a rate of SBI similar to younger infants and higher than older age infants. It is not appropriate to establish the approach to management of infants with fever based on a cut-off age of 2 weeks.
Pediatric Emergency Department, Cruces University Hospital, Bilbao, Basque Country, Spain.
Silvia
S
Garcia
Santiago
S
Mintegi
Borja
B
Gomez
Jorge
J
Barron
Mari
M
Pinedo
Nerea
N
Barcena
Elena
E
Martinez
Javier
J
Benito
D000367:Age Factors; D000553:Ambulatory Care; D001424:Bacterial Infections / Q000175:diagnosis* / Q000382:microbiology / Q000628:therapy*; D003430:Cross-Sectional Studies; D019468:Disease Management; D005260:Female; D005334:Fever / Q000175:diagnosis / Q000209:etiology / Q000628:therapy; D006760:Hospitalization; D006801:Humans; D007223:Infant; D007231:Infant, Newborn; D008297:Male; D017410:Practice Guidelines as Topic / Q000592:standards*