title: Microbiologic Agents in Parent-reported Neonatal Fever.
abstract: We reviewed etiology and outcome of consecutive neonates admitted to a neonatal unit for investigation of parent-reported fever (116 neonates over 24 months). Tympanic temperature was measured at the emergency department (Te) and core temperature at the neonatal unit (Tn). Microbials were isolated in 27 patients (23%); Te and Tn were both <38°C in 13 (48%) of the 27 patients. Microbial isolation was associated with older median age (16.7 vs. 8.0 days, p = 0.004), empirical antibiotic commencement (p = 0.0003) and longer hospital stay (median 8 vs. 4.0 days, p = 0.004). Compared with respiratory viral infection, patients with bacteremia had high C-reactive protein (p = 0.005) and likely to have comorbidity of meningitis (p = 0.077). Te ≥38°C had the highest sensitivity, positive likelihood ratio and positive and negative predictive ratios for bacteremia. Parent-reported fever was associated with a 3% incidence of meningitis, 6% of bacteremia and 9% of urinary tract infection. The majority of neonates with parent-reported fever do not have serious bacterial infection. Nevertheless, recommendations about threshold of antibiotic initiation are difficult, and empirical systemic antibiotic coverage must be commenced in those neonates with Te ≥38°C or elevated C-reactive protein.
authors.affiliation: Departments of Paediatrics, The Chinese University of Hong Kong, Prince of Wales Hospital, Shatin, Hong Kong ehon@cuhk.edu.hk.
authors.forename: Kam Lun
authors.initials: KL
authors.lastname: Hon
authors.affiliation: Division of Neonatology, Department of Pediatrics, University of British Columbia, Vancouver, Canada.
authors.forename: Joseph Yuk
authors.initials: JY
authors.lastname: Ting
authors.affiliation: Departments of Paediatrics, The Chinese University of Hong Kong, Prince of Wales Hospital, Shatin, Hong Kong.
authors.forename: Chung Mo
authors.initials: CM
authors.lastname: Chow
authors.affiliation: Departments of Paediatrics, The Chinese University of Hong Kong, Prince of Wales Hospital, Shatin, Hong Kong.
authors.forename: William
authors.initials: W
authors.lastname: Wong
authors.affiliation: Faculty of Medicine, The Chinese University of Hong Kong, Shatin, Hong Kong.
authors.forename: Wan Hang
authors.initials: WH
authors.lastname: Lau
authors.affiliation: Faculty of Medicine, The Chinese University of Hong Kong, Shatin, Hong Kong.
authors.forename: Wai Tat
authors.initials: WT
authors.lastname: Yeung
authors.affiliation: Faculty of Medicine, The Chinese University of Hong Kong, Shatin, Hong Kong.
authors.forename: Ka Ki Isabelle
authors.initials: KK
authors.lastname: Hung
authors.affiliation: Faculty of Medicine, The Chinese University of Hong Kong, Shatin, Hong Kong.
authors.forename: Carolyn
authors.initials: C
authors.lastname: Lee
authors.affiliation: Faculty of Medicine, The Chinese University of Hong Kong, Shatin, Hong Kong.
authors.forename: Tsz Ching Selina
authors.initials: TC
authors.lastname: Lee
authors.affiliation: Faculty of Medicine, The Chinese University of Hong Kong, Shatin, Hong Kong.
authors.forename: Ka Kei Kieran
authors.initials: KK
authors.lastname: Li
authors.affiliation: Departments of Paediatrics, The Chinese University of Hong Kong, Prince of Wales Hospital, Shatin, Hong Kong.
authors.forename: Ting Fan
authors.initials: TF
authors.lastname: Leung
mesh_terms: D000328:Adult; D000900:Anti-Bacterial Agents / Q000627:therapeutic use; D016470:Bacteremia / Q000188:drug therapy / Q000453:epidemiology / Q000382:microbiology*; D002097:C-Reactive Protein / Q000032:analysis*; D015897:Comorbidity; D004636:Emergency Service, Hospital; D005260:Female; D005334:Fever / Q000453:epidemiology / Q000209:etiology*; D006801:Humans; D007231:Infant, Newborn; D007902:Length of Stay; D008297:Male; D008581:Meningitis / Q000453:epidemiology*; D010290:Parents; D012189:Retrospective Studies; D014766:Viremia / Q000453:epidemiology / Q000821:virology
chemical_list: D000900:Anti-Bacterial Agents; D002097:C-Reactive Protein
keywords: Core temperature; E. coli; Fever; Neonates; empirical antibiotics; respiratory virus; streptococcus agalactiae