Febrile preemies in the ED

In this volume of The Journal, Greenhow et al present a large study of the incidence of invasive bacterial infections (IBI) in febrile infants, previously born preterm, who present to the emergency department (ED). It is widely recognized that fever in well appearing infants who present to the ED can be accompanied by IBI. The incidence ranges between 1% and 5% among children presenting with these findings. Because of the potential for serious morbidity, numerous clinical studies and guidelines from professional societies have been promulgated to address appropriate management of these children. However, the majority of studies and the guidelines did not address recommendations for infants previously born preterm. The rates of invasive bacterial infections in the NICU are well known to be higher among preterm infants. Thus, it has been assumed that former preterm infants who later present to the ED with fever are likewise at greater risk. This comprehensive study provides us now the most precise estimates of that risk. The records of almost 500 000 infants cared for in the Northern California Kaiser Permanente health system were reviewed. Ascertainment was based on the presence of blood and or cerebrospinal fluid cultures. Comparing term and preterm infants, the highest rate of IBI was in preterm infants (1.35 vs 0.69 per 100 000 person days), especially in those presenting at a younger chronological age. Kuppermann et al provide a thoroughly insightful review of this work and the impact on clinical management that these findings inure. Both articles are especially valuable in filling an important gap in our knowledge of how best to care for these vulnerable infants. Articles page 14 and page 171 Following Birth Hospitalization: Invasive Bacterial Infections in Preterm Infants Aged 7-90 DaysThe Journal of PediatricsVol. 252PreviewTo assess the incidence rate of invasive bacterial infections in preterm infants and compare invasive bacterial infection rates and pathogens between preterm and full-term infants at age 7-90 days. Full-Text PDF Clostridioides difficile Infection in Hospitalized Pediatric Patients: Comparisons of Epidemiology, Testing, and Treatment from 2013 to 2019The Journal of PediatricsVol. 252PreviewTo compare the incidence, epidemiology, testing patterns, treatment, and outcomes of Clostridioides difficile infection (CDI) among hospitalized pediatric patients from 2013 to 2019. Full-Text PDF Extended Risk of Mortality in Children with Inborn Errors of Metabolism: A Longitudinal Cohort StudyThe Journal of PediatricsVol. 252PreviewTo determine the long-term risk of mortality among children with inborn errors of metabolism. Full-Text PDF Associations Between Eating Speed, Diet Quality, Adiposity, and Cardiometabolic Risk FactorsThe Journal of PediatricsVol. 252PreviewTo assess the associations between eating speed, adiposity, cardiometabolic risk factors, and diet quality in a cohort of Spanish preschool-children. Full-Text PDF Open AccessFebrile Preterm Infants: They are Not Just Small Febrile, Term InfantsThe Journal of PediatricsVol. 252PreviewAnnually, more than 200 000 febrile infants younger than 90 days are evaluated in US emergency departments and other outpatient settings.1 Although urinary tract infections are common in these infants, the main concerns involve invasive bacterial infections, defined by bacteremia or bacterial meningitis. The reported invasive bacterial infection rates range from approximately 1% to 5% in prospective studies, with higher rates in the youngest infants.2-4 To address the persistent variability in care of these febrile infants despite substantial research performed over several decades, the American Academy of Pediatrics published guidelines for the management of well-appearing febrile infants 8-60 days old. Full-Text PDF