无血清降钙素原发热婴儿的优化处理。

IF 6.2 2区医学 Q1 PEDIATRICS Pediatrics Pub Date : 2025-02-01 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

摘要

背景：发热婴儿有侵袭性细菌感染(IBIs；菌血症或细菌性脑膜炎)。美国儿科学会（AAP）指南建议，当降钙素原检测不可用时，应使用c反应蛋白（CRP）、绝对中性粒细胞计数（ANC）和体温来识别低风险婴儿。当降钙素原不可用时，我们试图确定这些炎症标志物的最佳组合来预测IBI。方法：这是对2018年1月至2023年7月在三级儿科急诊科评估的所有60天或以下发热婴儿的前瞻性数据进行的二次分析。既往健康的8 - 60天足月婴儿，直肠温度为38.0°C或更高，符合AAP纳入/排除标准。通过分类和回归树分析得出决策规则，并与aap推荐的ANC≤5200/mm3、CRP≤20mg /L和温度≤38.5°C的阈值进行比较。结果：1987例婴儿中，38例（1.9%）患有IBIs。美国儿科学会推荐的阈值没有遗漏ibi(敏感性：100.0% [95% CI, 88.6%-100.0%]；阴性预测值（NPV）： 100.0% [95% CI, 99.5%-100.0%]；特异性：50.7% [95% CI, 48.5%-53.0%])。最佳衍生阈值为CRP≤22.2mg/L，温度≤39.0℃，ANC≤4500/mm3；尿液分析和年龄未被选择。导出的规则也没有遗漏ibi(敏感性：100.0% [95% CI, 88.6%-100.0%]；Npv: 100.0% [95% ci, 99.7%-100.0%])；然而，特异性提高到83.8% （95% CI, 82.1%-85.4%）。交叉验证规则的受试者工作曲线下面积（91.9% [95% CI, 91.1%-92.7%]）高于aap推荐的阈值(75.4% （95% CI, 74.3%-76.5%]）。结论：与aap推荐的阈值相比，结合ANC、CRP和统计导出阈值的温度可提高识别IBIs低风险婴儿的诊断准确性。

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Optimizing Management of Febrile Young Infants Without Serum Procalcitonin.

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.