The risk of serious bacterial infections among young ex-premature infants with fever.

Autor:	Barak-Corren Y; The Pediatrics Department, Shaare Zedek Medical Center, Jerusalem, Israel.; Predictive Medicine Group, Boston Children's Hospital, Boston, United States., Elizur Y; Faculty of Medicine, Hebrew University of Jerusalem, Jerusalem, Israel., Yuval S; The Pediatrics Department, Shaare Zedek Medical Center, Jerusalem, Israel., Burstyn A; Faculty of Medicine, Hebrew University of Jerusalem, Jerusalem, Israel., Deri N; Faculty of Medicine, Hebrew University of Jerusalem, Jerusalem, Israel., Schwartz S; The Pediatric Emergency Department, Shaare Zedek Medical Center, Jerusalem, Israel., Megged O; The Pediatrics Department, Shaare Zedek Medical Center, Jerusalem, Israel.; Faculty of Medicine, Hebrew University of Jerusalem, Jerusalem, Israel.; The Pediatric Infectious Disease Unit, Shaare Zedek Medical Center, Jerusalem, Israel., Toker O; The Pediatrics Department, Shaare Zedek Medical Center, Jerusalem, Israel.; Faculty of Medicine, Hebrew University of Jerusalem, Jerusalem, Israel.; The Allergy and Clinical Immunology Unit, Shaare Zedek Medical Center, Jerusalem, Israel.
Jazyk:	angličtina
Zdroj:	Frontiers in pediatrics [Front Pediatr] 2022 Oct 12; Vol. 10, pp. 1021007. Date of Electronic Publication: 2022 Oct 12 (Print Publication: 2022).
DOI:	10.3389/fped.2022.1021007
Abstrakt:	Background and Objectives: To determine the rate of serious-bacterial-infections (SBI) in young ex-premature infants with fever, and to develop a risk-stratification algorithm for these patients. Methods: A retrospective cohort study including all infants who presented to the pediatric emergency department (ED) of a tertiary-care university-hospital between 2010 and 2020 with fever (≥38°C), were born prematurely (<37-weeks), had post-conception age of <52-weeks, and had available blood, urine, or CSF cultures. The rates of SBI by age-of-birth and age-at-visit were calculated and compared to a cohort of matched full-term controls. Results: The study included a total of 290 ex-premature cases and 290 full-term controls. There were 11 cases (3.8%) with an invasive bacterial infection (IBI) of either bacteremia, meningitis or both and only six controls (2.1%) with IBI ( p  = 0.32). Over 28-days chronologic-age, there were 10 (3.6%) IBIs among cases and no IBIs among the controls ( p  = 0.02). There were eight (3%) cases and three (1%) controls with IBI who were well-appearing on physical examination ( p  = 0.19). All eight well-appearing ex-premature infants were under 60-days adjusted-age, seven of whom (88%) were also under 28-days adjusted-age. There were 28 (10.6%) cases and 34 (12%) controls with urinary tract infection (UTI) ( p  = 0.5). Among cases under 60-days adjusted-age, urinalysis was not reliable to exclude UTI (50% negative). Conclusions: Well-appearing ex-preterm infants have a significant risk for IBI until the adjusted age of 28-days and for UTI until the adjusted age of 60-days. Further studies are needed to evaluate the approach to fever in this unique population. Competing Interests: The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest. (© 2022 Barak-Corren, Elizur, Yuval, Burstyn, Deri, Schwartz, Megged and Toker.)
Databáze:	MEDLINE
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