Infants ≤60 days old with fever by history only, a normal urinalysis result, and an absolute neutrophil count <5185 cells per μL have a low probability of invasive bacterial infection (IBI)

A Prediction Model to Identify Febrile Infants ≤60 Days at Low Risk of Invasive Bacterial Infection

Paul L. Aronson, Veronika Shabanova, Eugene D. Shapiro, Marie E. Wang, Lise E. Nigrovic, Christopher M. Pruitt, Adrienne G. DePorre, Rianna C. Leazer, Sanyukta Desai, Laura F. Sartori, Richard D. Marble, Sahar N. Rooholamini, Russell J. McCulloh, Christopher Woll, Fran Balamuth, Elizabeth R. Alpern, Samir S. Shah, Derek J. Williams, Whitney L. Browning, Nipam Shah, Mark I. Neuman, for the Febrile Young Infant Research Collaborative

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OBJECTIVES: To derive and internally validate a prediction model for the identification of febrile infants ≤60 days old at low probability of invasive bacterial infection (IBI).

METHODS: We conducted a case-control study of febrile infants ≤60 days old who presented to the emergency departments of 11 hospitals between July 1, 2011 and June 30, 2016. Infants with IBI, defined by growth of a pathogen in blood (bacteremia) and/or cerebrospinal fluid (bacterial meningitis), were matched by hospital and date of visit to 2 control patients without IBI. Ill-appearing infants and those with complex chronic conditions were excluded. Predictors of IBI were identified with multiple logistic regression and internally validated with 10-fold cross-validation, and an IBI score was calculated.

RESULTS: We included 181 infants with IBI (155 [85.6%] with bacteremia without meningitis and 26 [14.4%] with bacterial meningitis) and 362 control patients. Twenty-three infants with IBI (12.7%) and 138 control patients (38.1%) had fever by history only. Four predictors of IBI were identified (area under the curve 0.83 [95% confidence interval (CI): 0.79–0.86]) and incorporated into an IBI score: age <21 days (1 point), highest temperature recorded in the emergency department 38.0–38.4°C (2 points) or ≥38.5°C (4 points), absolute neutrophil count ≥5185 cells per μL (2 points), and abnormal urinalysis results (3 points). The sensitivity and specificity of a score ≥2 were 98.8% (95% CI: 95.7%–99.9%) and 31.3% (95% CI: 26.3%–36.6%), respectively. All 26 infants with meningitis had scores ≥2.

CONCLUSIONS: Infants ≤60 days old with fever by history only, a normal urinalysis result, and an absolute neutrophil count <5185 cells per μL have a low probability of IBI.

Accepted January 16, 2019.

Copyright © 2019 by the American Academy of Pediatrics

Alexandros Sfakianakis
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