May 20, 2019Pediatrics
According to an article published in JAMA Pediatrics (19 February 2019), a new protocol could help emergency room physicians to rule out life-threatening bacterial infections among infants up to 2 months of age who have fevers, thus potentially eliminating the need for spinal taps, unnecessary antibiotic treatments or expensive hospital stays.
The authors from the Pediatric Emergency Care Applied Research Network (PECARN) developed the protocol from a study of more than 1,800 infants seen at 26 emergency departments around the country. PECARN, a research network of 18 pediatric emergency departments and 9 emergency medical services agencies, and is funded by the Maternal and Child Health Bureau of NIH.
Previous studies suggest that 8 to 13% of infants up to 2 months of age who have a fever may have a serious bacterial infection (SBI). These include urinary tract infections, bacteremia (bacteria in the blood) and bacterial meningitis (bacterial infection of the membrane housing the brain and spinal cord). Often, a physician will need to confirm a diagnosis with a spinal tap (lumbar puncture), in which a small amount of fluid is extracted from the spinal canal. Although complications of the procedure are rare, they include inflammation of the spinal canal, bleeding and headache. In addition, an infant may be given antibiotics when a bacterial infection is suspected and may be admitted to a hospital for observation.
The new protocol measures the levels of bacteria in urine, of procalcitonin (a substance produced in response to bacterial infection) in serum, and of neutrophils (an infection-fighting white blood cell). The authors were able to diagnose a SBI, if tests showed low levels of bacteria and procalcitonin and a normal neutrophil count. They were also able to accurately rule out all but three of the 170 cases of SBI ultimately detected, including all cases of meningitis. The authors note that their findings need to be verified in a larger sample before they can be applied to medical practice.