Guidelines lack capacity to predict serious infections in febrile infants
For febrile infants younger than 3 months old, current heart rate guidelines have variable performances, a recent Singapore study has found. Particularly, while the Advanced Paediatric Life Support (APLS) guideline had the greatest sensitivity, no individual guideline could satisfactorily predict serious infections (SIs).
A retrospective review of 1,057 infants (mean age 1.1±1.0 months), recruited from the KK Women’s and Children’s Hospital in Singapore, showed that the rate of SIs was 30.8 percent (n=326). A larger proportion of infants with SIs were administered ampicillin and gentamicin after admission (p<0.001 for both).
Univariate analysis identified temperature (p<0.001), heart rate (p=0.006), triage category (p=0.019), and Severity Index Score (SIS) category (p=0.005), total white blood cell count (p<0.001), absolute neutrophil count (p<0.001), platelet count (p=0.001) and C-reactive protein concentrations (p<0.001) as significantly predictive of SIs.
The most common SI was urinary tract infection, observed in 178 infants. The most common pathogens associated with this infection were Escherichia coli, Klebsiella pneumoniae and Enterococcus faecalis. Meningitis (n=112), septicaemia (n=21), and lobar pneumonia (n=7) were also commonly observed, with E. coli as a common cause.
Aside from the APLS, the Fleming normal reference values also resulted in a high sensitivity for abnormal heart rate (66.0 and 62.6 percent, respectively). Both also had the highest negative predictive values (73.3 and 71.4 percent, respectively).
In contrast, the Paediatric Canadian Triage and Acuity Scale yielded corresponding values of 23.0 and 69.5 percent. None of the guidelines examined reached a sensitivity of >70 percent.