Optimizing Management of Febrile Young Infants Without Serum Procalcitonin.

IF 6.2 2区医学 Q1 PEDIATRICS Pediatrics Pub Date : 2025-01-02 DOI:10.1542/peds.2024-068200

Brett Burstein, Caroline Wolek, Cassandra Poirier, Alexandra Yannopoulos, T Charles Casper, Mohammed Kaouache, Nathan Kuppermann

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引用次数: 0

Abstract

Background: Febrile young infants are at risk of invasive bacterial infections (IBIs; bacteremia or bacterial meningitis). American Academy of Pediatrics (AAP) guidelines recommend that when procalcitonin testing is unavailable, C-reactive protein (CRP), absolute neutrophil count (ANC) and temperature should be used to identify low-risk infants. We sought to determine the optimal combination of these inflammatory markers to predict IBI when procalcitonin is unavailable.

Methods: This was a secondary analysis of prospectively collected data for all febrile infants aged 60 days or younger evaluated at a tertiary pediatric emergency department (January 2018 to July 2023). Previously healthy term infants aged 8 to 60 days with rectal temperatures of 38.0°C or greater meeting AAP inclusion/exclusion criteria were analyzed. A decision rule was derived by classification and regression tree analysis with 10-fold cross-validation then compared to AAP-recommended thresholds of ANC ≤ 5200/mm3, CRP ≤ 20 mg/L, and temperature ≤ 38.5°C.

Results: Among 1987 infants, 38 (1.9%) had IBIs. The AAP-recommended thresholds missed no IBIs (sensitivity: 100.0% [95% CI, 88.6%-100.0%]; negative predictive value (NPV): 100.0% [95% CI, 99.5%-100.0%]; specificity: 50.7% [95% CI, 48.5%-53.0%]). Optimal derived thresholds were CRP ≤ 22.2mg/L, temperature ≤ 39.0°C, and ANC ≤ 4500/mm3; urinalysis and age were not selected. The derived rule also missed no IBIs (sensitivity: 100.0% [95% CI, 88.6%-100.0%]; NPV: 100.0% [95% CI, 99.7%-100.0%]); however, specificity improved to 83.8% (95% CI, 82.1%-85.4%). Area under the receiver operating curve for the cross-validated rule (91.9% [95% CI, 91.1%-92.7%]) was higher than at AAP-recommended thresholds (75.4% (95% CI, 74.3%-76.5%]).

Conclusions: The combination of ANC, CRP, and temperature at statistically derived thresholds improved diagnostic accuracy for identifying infants at low risk of IBIs compared to AAP-recommended thresholds.

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来源期刊

Pediatrics 医学-小儿科

CiteScore

12.80

自引率

5.00%

发文量

791

审稿时长

2-3 weeks

期刊介绍： The Pediatrics® journal is the official flagship journal of the American Academy of Pediatrics (AAP). It is widely cited in the field of pediatric medicine and is recognized as the leading journal in the field. The journal publishes original research and evidence-based articles, which provide authoritative information to help readers stay up-to-date with the latest developments in pediatric medicine. The content is peer-reviewed and undergoes rigorous evaluation to ensure its quality and reliability. Pediatrics also serves as a valuable resource for conducting new research studies and supporting education and training activities in the field of pediatrics. It aims to enhance the quality of pediatric outpatient and inpatient care by disseminating valuable knowledge and insights. As of 2023, Pediatrics has an impressive Journal Impact Factor (IF) Score of 8.0. The IF is a measure of a journal's influence and importance in the scientific community, with higher scores indicating a greater impact. This score reflects the significance and reach of the research published in Pediatrics, further establishing its prominence in the field of pediatric medicine.

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