TY - JOUR
T1 - A search for the 'Holy Grail' in the evaluation of febrile neonates aged 28 days or less
T2 - A prospective study
AU - Bilavsky, Efraim
AU - Ashkenazi-Hoffnung, Liat
AU - Yarden-Bilavsky, Havatzelet
AU - Amir, Jacob
AU - Livni, Gilat
PY - 2011/4
Y1 - 2011/4
N2 - Objective: To determine the reliability of low-risk criteria to exclude serious bacterial infection (SBI) in febrile neonates aged ≤?28 days. Methods: All febrile neonates who were hospitalized for fever evaluation were prospectively divided into 2 groups by risk status for SBI. The following criteria were used to define low risk: (1) unremarkable medical history; (2) well-appearing; (3) no focal signs of infection; (4) white blood cell count between 5000 and 15,000/mm 3; (5) normal urinalysis; (6) no mucoid or bloody diarrhoea. Results: Of the 465 enrolled neonates, 177 (38.1%) were considered high risk for SBI and 288 (61.9%) low risk. SBIs were found in 55 (31.1%) neonates in the high-risk group compared to 10 (3.5%) in the low-risk group (p < 0.001). The sensitivity, specificity, positive predictive value and negative predictive value of the criteria for all types of SBI were 84.6% (95% confidence interval (CI) 73.9-91.4%), 69.5% (95% CI 64.8-73.8%), 31% (95% CI 27.3-35.1%) and 96.5% (95% CI 94.3-98%), respectively. Conclusions: The defined criteria are not sufficiently reliable to exclude an SBI or an invasive SBI. We therefore suggest that all febrile neonates in this age group should be hospitalized for complete evaluation and consideration of empirical intravenous antibiotic treatment.
AB - Objective: To determine the reliability of low-risk criteria to exclude serious bacterial infection (SBI) in febrile neonates aged ≤?28 days. Methods: All febrile neonates who were hospitalized for fever evaluation were prospectively divided into 2 groups by risk status for SBI. The following criteria were used to define low risk: (1) unremarkable medical history; (2) well-appearing; (3) no focal signs of infection; (4) white blood cell count between 5000 and 15,000/mm 3; (5) normal urinalysis; (6) no mucoid or bloody diarrhoea. Results: Of the 465 enrolled neonates, 177 (38.1%) were considered high risk for SBI and 288 (61.9%) low risk. SBIs were found in 55 (31.1%) neonates in the high-risk group compared to 10 (3.5%) in the low-risk group (p < 0.001). The sensitivity, specificity, positive predictive value and negative predictive value of the criteria for all types of SBI were 84.6% (95% confidence interval (CI) 73.9-91.4%), 69.5% (95% CI 64.8-73.8%), 31% (95% CI 27.3-35.1%) and 96.5% (95% CI 94.3-98%), respectively. Conclusions: The defined criteria are not sufficiently reliable to exclude an SBI or an invasive SBI. We therefore suggest that all febrile neonates in this age group should be hospitalized for complete evaluation and consideration of empirical intravenous antibiotic treatment.
KW - Neonatal fever
KW - Rochester criteria
KW - bacteraemia
KW - sepsis work-up
KW - serious bacterial infection
KW - urinary tract infection
UR - http://www.scopus.com/inward/record.url?scp=79952640461&partnerID=8YFLogxK
U2 - 10.3109/00365548.2010.544670
DO - 10.3109/00365548.2010.544670
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C2 - 21171828
AN - SCOPUS:79952640461
SN - 0036-5548
VL - 43
SP - 264
EP - 268
JO - Scandinavian Journal of Infectious Diseases
JF - Scandinavian Journal of Infectious Diseases
IS - 4
ER -