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ObjectiveDescribe emergency department (ED) management and patient outcomes for febrile infants 29-60 days of age who received a lumbar puncture (LP), with focus on timing of antibiotics and type of physician performing LP.MethodsRetrospective observational study of 35 California EDs from January 1, 2010 through December 31, 2019. Primary analysis was among patients with successful LP and primary outcome was hospital length of stay (LOS). Logistic regression analysis included variables associated with LOS of at least 2 days. Secondary outcomes were bacterial meningitis, hospital admission, length of antibiotics, and readmission.ResultsAmong 2569 febrile infants (median age 39 days), 667 underwent successful LP and 633 received intravenous antibiotics. Most infants (n = 559, 88.3%) had their LP before intravenous antibiotic administration. Pediatricians performed 54% of LPs and emergency physicians 34%. Sixteen infants (0.6% of 2569) were diagnosed with bacterial meningitis, and none died. Five hundred and fifty-eight (88%) infants receiving an LP were hospitalized. Among patients receiving an LP and antibiotics (n = 633), 6.5% were readmitted within 30 days. Patients receiving antibiotics before LP had a longer length of antibiotics (+ 7.9 hours, 95% confidence interval [CI] 3.8-13.4). Primary analysis found no association between timing of antibiotics and LOS (odds ratio [OR] 0.67, 95% CI 0.34-1.30), but shorter LOS when emergency physicians performed the LP (OR 0.66, 95% CI 0.45-0.97).ConclusionsFebrile infants in the ED had no deaths and few cases of bacterial meningitis. In community EDs, where a pediatrician is often not available, successful LP by emergency physician was associated with reduced inpatient LOS.

ObjectiveTo assess the utility of a panviral DNA microarray platform (Virochip) in the detection of viruses associated with pediatric respiratory tract infections (RTIs).Study designThe Virochip was compared with conventional direct fluorescent antibody (DFA)- and polymerase chain reaction (PCR)-based testing for the detection of respiratory viruses in 278 consecutive nasopharyngeal aspirate samples from 222 children.ResultsThe Virochip was superior in performance to DFA, showing a 19% increase in the detection of 7 respiratory viruses included in standard DFA panels, and was similar to virus-specific PCR (sensitivity, 85% to 90%; specificity, >/=99%; positive predictive value, 94% to 96%; negative predictive value, 97% to 98%) in the detection of respiratory syncytial virus, influenza A, and rhinoviruses/enteroviruses. The Virochip also detected viruses not routinely tested for or missed by DFA and PCR, as well as double infections and infections in critically ill patients that DFA failed to detect.ConclusionsGiven its favorable sensitivity and specificity profile and expanded spectrum for detection, microarray-based viral testing holds promise for clinical diagnosis of pediatric RTIs.

A 5-week-old infant female admitted for fever without a source subsequently tested positive for severe acute respiratory syndrome coronavirus 2. She had a mild hospital course without respiratory distress. This unexpected presentation changed regional hospital screening for coronavirus disease 2019 and personal protective equipment use by medical providers who evaluate febrile infants. [ABSTRACT FROM AUTHOR]

The article provides information on severe hand, foot, and mouth disease (HFMD) associated with coxsackievirus A6 in the U.S. from November 2011 to February 2012. The U.S. Centers for Disease Control and Prevention (CDC) received reports of 63 persons with signs and symptoms of HFMD or with fever and atypical rash in Alabama, California, Connecticut, and Nevada. Ways HFMD is spread include contact with saliva, respiratory secretions, fluid in vesicles, and feces.

The article reports that the U.S. Centers for Disease Control and Prevention (CDC) received reports of 63 persons with signs and symptoms of hand, foot and mouth disease (HFMD) associated with coxsackievirusA6 in Alabama, California, and Connecticut from November 7, 2011 to February 29, 2012. It states that the age ranges of patients, severity of illness, and seasonality of disease in these cases were unusual for HFMD in the U.S.

Background: Invasive bacterial infections (IBIs) in febrile infants are rare but potentially devastating. We aimed to derive and validate a predictive model for IBI among febrile infants age 7-60 days., Methods: Data were abstracted retrospectively from electronic records of 37 emergency departments (EDs) for infants with a measured temperature >=100.4 F who underwent an ED evaluation with blood and urine cultures. Models to predict IBI were developed and validated respectively using a random 80/20 dataset split, including 10-fold cross-validation. We used precision recall curves as the classification metric., Results: Of 4411 eligible infants with a mean age of 37 days, 29% had characteristics that would likely have excluded them from existing risk stratification protocols. There were 196 patients with IBI (4.4%), including 43 (1.0%) with bacterial meningitis. Analytic approaches varied in performance characteristics (precision recall range 0.04-0.29, area under the curve range 0.5-0.84), with the XGBoost model demonstrating the best performance (0.29, 0.84). The five most important variables were serum white blood count, maximum temperature, absolute neutrophil count, absolute band count, and age in days., Conclusion: A machine learning model (XGBoost) demonstrated the best performance in predicting a rare outcome among febrile infants, including those excluded from existing algorithms., Impact: Several models for the risk stratification of febrile infants have been developed. There is a need for a preferred comprehensive model free from limitations and algorithm exclusions that accurately predicts IBIs. This is the first study to derive an all-inclusive predictive model for febrile infants aged 7-60 days in a community ED sample with IBI as a primary outcome. This machine learning model demonstrates potential for clinical utility in predicting IBI., (© 2024. The Author(s), under exclusive licence to the International Pediatric Research Foundation, Inc.)

Objectives: The Roseville Protocol modifies the Rochester Protocol by adding a high-risk temperature criterion of >38.5°C for infants 7 to 28 days old and by allowing febrile infants 29 to 60 days old with abnormal urinalysis but reassuring complete blood cell counts to be discharged home on oral antibiotics without receiving a lumbar puncture (LP). In this study, we define the Roseville Protocol test characteristics to detect invasive bacterial infection (IBI) and retrospectively compare its performance to that of the Rochester, Philadelphia, and Boston protocols., Methods: In this retrospective study, we examine all cases of fever in infants aged 7 to 60 days presenting to a large health maintenance organization from 2007 to 2016 and having requisite laboratory tests for protocol analysis. The 4 protocols were retrospectively applied to this cohort to calculate each protocol's sensitivity and specificity to detect IBI. Protocols were compared regarding recommended LPs, admissions, and parenteral antibiotics., Results: In 627 infants 7 to 28 days old, the Roseville Protocol had a sensitivity of 96.7% and a negative predictive value of 99.5%. It identified 2 IBIs missed by the Rochester Protocol but recommended an absolute increase of 19% in LPs and admissions. In 1176 infants 29 to 60 days old, the Roseville Protocol had a sensitivity of 91.4% and a negative predictive value of 99.6%. There was an absolute reduction in LPs by 18% to 44% compared to the Rochester Protocol and by 74% to 100% compared to the Philadelphia and Boston protocols. There was an absolute reduction in admissions by 18% to 44% compared to the Rochester Protocol, by 25% to 51% compared to the Philadelphia Protocol, and by 10% to 36% compared to the Boston Protocol., Conclusions: The Roseville Protocol has sensitivity and specificity comparable to that of existing protocols for IBI in febrile infants 7 to 60 days old, while allowing for fewer invasive procedures and hospitalizations in infants ≥29 days old., Competing Interests: POTENTIAL CONFLICT OF INTEREST: The authors have indicated they have no potential conflicts of interest to disclose., (Copyright © 2021 by the American Academy of Pediatrics.)