A prospective study was undertaken to evaluate the usefulness of low risk criteria for identifying febrile neonates unlikely to have bacterial infections, particularly bacteremia and meningitis.
Using these criteria we wished to check whether these low risk neonates can be safely managed as inpatients under close observation but without receiving empiric antibiotic therapy.
We conducted a prospective study of 250 consecutive infants 28 days of age or less (range, 4 to 28 days) who had rectal temperatures of at least 38°C. After a complete history, physical examination and sepsis workup, the 131 febrile neonates with clinical and laboratory findings indicating low risk for bacterial infections were hospitalized, closely observed and not given antibiotics.
The low risk criteria used to identify these neonates included well appearance ; absence of physical signs of an ear, eye or soft tissue infection ; a white blood cell count of 5000 to 15 000/mm3, a neutrophil band form count of<1500/mm3, a spun urine specimen that had<10 white blood cells per high power field on microscopy and a C-reactive protein value of<20 mg/l. The remaining 119 febrile neonates who did not meet the low risk criteria were hospitalized and given empiric antibiotics pending culture results.
The overall incidence of bacterial infections in the 250 febrile neonates was 16.4% (41 neonates) with bacteremia and/or meningitis occurring in 4.4% (11 neonates). (...)
Mots-clés Pascal : Fièvre, Facteur risque, Infection, Diagnostic, Critère décision, Indice gravité, Relation, Indication, Chimiothérapie, Antibiotique, Résultat, Nouveau né, Homme, Bactériose
Mots-clés Pascal anglais : Fever, Risk factor, Infection, Diagnosis, Decision criterion, Severity score, Relation, Indication, Chemotherapy, Antibiotic, Result, Newborn, Human, Bacteriosis
Notice produite par :
Inist-CNRS - Institut de l'Information Scientifique et Technique
Cote : 97-0147833
Code Inist : 002B05A03. Création : 21/05/1997.