Approach to Neonates and Young Infants with Fever without a Source Who Are at Risk for Severe Bacterial Infection
Introduction. Among neonates and infants <3 months of age with fever without a source (FWS), 5% to 15% of cases are patients with fever caused by a serious bacterial infection (SBI). To favour the differentiation between low- and high-risk infants, several algorithms based on analytical and clini...
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| Format: | Article |
| Language: | English |
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Wiley
2018-01-01
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| Series: | Mediators of Inflammation |
| Online Access: | http://dx.doi.org/10.1155/2018/4869329 |
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| author | Susanna Esposito Victoria Elisa Rinaldi Alberto Argentiero Edoardo Farinelli Marta Cofini Renato D’Alonzo Antonella Mencacci Nicola Principi |
| author_facet | Susanna Esposito Victoria Elisa Rinaldi Alberto Argentiero Edoardo Farinelli Marta Cofini Renato D’Alonzo Antonella Mencacci Nicola Principi |
| author_sort | Susanna Esposito |
| collection | DOAJ |
| description | Introduction. Among neonates and infants <3 months of age with fever without a source (FWS), 5% to 15% of cases are patients with fever caused by a serious bacterial infection (SBI). To favour the differentiation between low- and high-risk infants, several algorithms based on analytical and clinical parameters have been developed. The aim of this review is to describe the management of young infants with FWS and to discuss the impact of recent knowledge regarding FWS management on clinical practice. Materials and Methods. PubMed was used to search for all of the studies published over the last 35 years using the keywords: “fever without source” or “fever of unknown origin” or “meningitis” or “sepsis” or “urinary tract infection” and “neonate” or “newborn” or “infant <90 days of life” or “infant <3 months”. Results and Discussion. The selection of neonates and young infants who are <3 months old with FWS who are at risk for SBI remains a problem without a definitive solution. The old Rochester criteria remain effective for identifying young infants between 29 and 60 days old who do not have severe bacterial infections (SBIs). However, the addition of laboratory tests such as C-reactive protein (CRP) and procalcitonin (PCT) can significantly improve the identification of children with SBI. The approach in evaluating neonates is significantly more complicated, as their risk of SBIs, including bacteremia and meningitis, remains relevant and none of the suggested approaches can reduce the risk of dramatic mistakes. In both groups, the best antibiotic must be carefully selected considering the clinical findings, the laboratory data, the changing epidemiology, and increasing antibiotic resistance of the most common infectious bacteria. |
| format | Article |
| id | doaj-art-8cb93ae8822f4dd58d911733f5ccf7d5 |
| institution | Kabale University |
| issn | 0962-9351 1466-1861 |
| language | English |
| publishDate | 2018-01-01 |
| publisher | Wiley |
| record_format | Article |
| series | Mediators of Inflammation |
| spelling | doaj-art-8cb93ae8822f4dd58d911733f5ccf7d52025-08-20T03:37:44ZengWileyMediators of Inflammation0962-93511466-18612018-01-01201810.1155/2018/48693294869329Approach to Neonates and Young Infants with Fever without a Source Who Are at Risk for Severe Bacterial InfectionSusanna Esposito0Victoria Elisa Rinaldi1Alberto Argentiero2Edoardo Farinelli3Marta Cofini4Renato D’Alonzo5Antonella Mencacci6Nicola Principi7Pediatric Clinic, Department of Surgical and Biomedical Sciences, Università degli Studi di Perugia, Perugia, ItalyPediatric Clinic, Department of Surgical and Biomedical Sciences, Università degli Studi di Perugia, Perugia, ItalyPediatric Clinic, Department of Surgical and Biomedical Sciences, Università degli Studi di Perugia, Perugia, ItalyPediatric Clinic, Department of Surgical and Biomedical Sciences, Università degli Studi di Perugia, Perugia, ItalyPediatric Clinic, Department of Surgical and Biomedical Sciences, Università degli Studi di Perugia, Perugia, ItalyPediatric Clinic, Department of Surgical and Biomedical Sciences, Università degli Studi di Perugia, Perugia, ItalyMicrobiology Unit, Department of Medicine, Università degli Studi di Perugia, Perugia, ItalyPediatrics, Università degli Studi di Milano, Milan, ItalyIntroduction. Among neonates and infants <3 months of age with fever without a source (FWS), 5% to 15% of cases are patients with fever caused by a serious bacterial infection (SBI). To favour the differentiation between low- and high-risk infants, several algorithms based on analytical and clinical parameters have been developed. The aim of this review is to describe the management of young infants with FWS and to discuss the impact of recent knowledge regarding FWS management on clinical practice. Materials and Methods. PubMed was used to search for all of the studies published over the last 35 years using the keywords: “fever without source” or “fever of unknown origin” or “meningitis” or “sepsis” or “urinary tract infection” and “neonate” or “newborn” or “infant <90 days of life” or “infant <3 months”. Results and Discussion. The selection of neonates and young infants who are <3 months old with FWS who are at risk for SBI remains a problem without a definitive solution. The old Rochester criteria remain effective for identifying young infants between 29 and 60 days old who do not have severe bacterial infections (SBIs). However, the addition of laboratory tests such as C-reactive protein (CRP) and procalcitonin (PCT) can significantly improve the identification of children with SBI. The approach in evaluating neonates is significantly more complicated, as their risk of SBIs, including bacteremia and meningitis, remains relevant and none of the suggested approaches can reduce the risk of dramatic mistakes. In both groups, the best antibiotic must be carefully selected considering the clinical findings, the laboratory data, the changing epidemiology, and increasing antibiotic resistance of the most common infectious bacteria.http://dx.doi.org/10.1155/2018/4869329 |
| spellingShingle | Susanna Esposito Victoria Elisa Rinaldi Alberto Argentiero Edoardo Farinelli Marta Cofini Renato D’Alonzo Antonella Mencacci Nicola Principi Approach to Neonates and Young Infants with Fever without a Source Who Are at Risk for Severe Bacterial Infection Mediators of Inflammation |
| title | Approach to Neonates and Young Infants with Fever without a Source Who Are at Risk for Severe Bacterial Infection |
| title_full | Approach to Neonates and Young Infants with Fever without a Source Who Are at Risk for Severe Bacterial Infection |
| title_fullStr | Approach to Neonates and Young Infants with Fever without a Source Who Are at Risk for Severe Bacterial Infection |
| title_full_unstemmed | Approach to Neonates and Young Infants with Fever without a Source Who Are at Risk for Severe Bacterial Infection |
| title_short | Approach to Neonates and Young Infants with Fever without a Source Who Are at Risk for Severe Bacterial Infection |
| title_sort | approach to neonates and young infants with fever without a source who are at risk for severe bacterial infection |
| url | http://dx.doi.org/10.1155/2018/4869329 |
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