Febrile neonates

Study Objective: To derive and validate a clinical prediction rule that identifies febrile infants ≤60 days old at low risk for SBIs (UTI, bacteremia, meningitis), aiming to reduce unnecessary lumbar punctures, antibiotics, and hospitalizations.
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 Summary of the 2019 JAMA Pediatrics study by Kuppermann et al. on identifying febrile infants at low risk for serious bacterial infections (SBIs):
Study Design

• Type: Prospective, multicenter observational study
• Sites: 26 emergency departments across the U.S.
• Period: March 2011 – May 2013
• Sample Size: 1821 previously healthy febrile infants
• Validation Cohort: 913 infants

Prediction Rule VariablesInfants were classified as low risk if they met all three criteria:

1. Negative urinalysis
2. Absolute neutrophil count (ANC) ≤4090/μL
3. Serum procalcitonin ≤1.71 ng/mL

Key Results:
Sensitivity
97.7%

Specificity
60.0%

Negative Predictive Value
99.6%

Missed SBIs
3 infants (2 UTIs, 1 bacteremia)

Missed Meningitis
0 cases

Clinical Implications

• High accuracy in ruling out SBIs without relying on CSF analysis.
• Potential to reduce lumbar punctures and hospital admissions, especially in infants >28 days.
• Straightforward implementation using objective lab values.

 Limitations

• Only 30 infants had bacteremia or meningitis.
• Further external validation needed before widespread adoption.
• Caution advised for infants ≤28 days due to higher risk of invasive infections and HSV.