Abstract
Objective Few prospective studies have assessed the occurrence of radiographic pneumonia in young febrile infants. We analyzed factors associated with radiographic pneumonias in febrile infants 60 days or younger evaluated in pediatric emergency departments. Study Design We conducted a planned secondary analysis of a prospective cohort study within 26 emergency departments in a pediatric research network from 2008 to 2013. Febrile (≥38°C) infants 60 days or younger who received chest radiographs were included. Chest radiograph reports were categorized as "no,""possible,"or "definite"pneumonia. We compared demographics, Yale Observation Scale scores (>10 implying ill appearance), laboratory markers, blood cultures, and viral testing among groups. Results Of 4778 infants, 1724 (36.1%) had chest radiographs performed; 2.7% (n = 46) had definite pneumonias, and 3.9% (n = 67) had possible pneumonias. Patients with definite (13/46 [28.3%]) or possible (15/67 [22.7%]) pneumonias more frequently had Yale Observation Scale score >10 compared with those without pneumonias (210/1611 [13.2%], P = 0.002) in univariable and multivariable analyses. Median white blood cell count (WBC), absolute neutrophil count (ANC), and procalcitonin (PCT) were higher in the definite (WBC, 11.5 [interquartile range, 9.8-15.5]; ANC, 5.0 [3.2-7.6]; PCT, 0.4 [0.2-2.1]) versus no pneumonia (WBC, 10.0 [7.6-13.3]; ANC, 3.4 [2.1-5.4]; PCT, 0.2 [0.2-0.3]; WBC, P = 0.006; ANC, P = 0.002; PCT, P = 0.046) groups, but of unclear clinical significance. There were no cases of bacteremia in the definite pneumonia group. Viral infections were more frequent in groups with definite (25/38 [65.8%]) and possible (28/55 [50.9%]) pneumonias than no pneumonias (534/1185 [45.1%], P = 0.02). Conclusions Radiographic pneumonias were uncommon, often had viruses detected, and were associated with ill appearance, but few other predictors, in febrile infants 60 days or younger.
Original language | English (US) |
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Pages (from-to) | E221-E226 |
Journal | Pediatric emergency care |
Volume | 37 |
Issue number | 5 |
DOIs | |
State | Published - 2021 |
Funding
From the *Division of Emergency Medicine, Ann and Robert H. Lurie Children's Hospital of Chicago & Department of Pediatrics, Northwestern University Feinberg School of Medicine, Chicago, IL; †Division of Pediatric Infectious Diseases and Center for Vaccines and Immunity, Nationwide Children's Hospital and The Ohio State University, Columbus, OH; ‡Departments of Emergency Medicine and Pediatrics, MD School of Medicine, Western Michigan University Homer Stryker, Kalamazoo, MI; §American Academy of Pediatrics, Elk Grove, IL; ||Department of Emergency Medicine, University of California Davis School of Medicine, Sacramento, CA; ¶Division of Emergency Medicine, Department of Pediatrics, Children's National Medical Center, The George Washington School of Medicine and Health Sciences, Washington, DC; #Section of Emergency Medicine, Department of Pediatrics, Nationwide Children's Hospital and The Ohio State University, Columbus, OH; **Department of Pediatrics, University of Utah, Salt Lake City, UT; ††Department of Emergency Medicine, University of Michigan, Ann Arbor, MI; and ‡‡Departments of Emergency Medicine and Pediatrics, University of California Davis School of Medicine, Sacramento, CA. Former affiliation of J.D.H.: Department of Emergency Medicine, Helen DeVos Children's Hospital of Spectrum Health, Grand Rapids, MI. Former affiliation of D.M.J.: Department of Pediatrics, St Louis Children's Hospital, Washington University, St Louis, MO. Former affiliation of P.M.: Division of Emergency Medicine, Department of Pediatrics, Children's Hospital of Michigan, Wayne State University, Detroit, MI. Former Affiliation of T.A.F.: Division of Emergency Medicine, Cincinnati Children's Hospital Medical Center, Department of Pediatrics, University of Cincinnati College of Medicine, Cincinnati, OH. The research reported in this publication was supported in part by grant H34MCO8509 from Health Resources and Services Administration, Emergency Services for Children, and by the Eunice Kennedy Shriver National Institute of Child Health and Human Development of the National Institutes of Health under award number R01HD062477. Dr Florin's effort was supported in part by the National Institute of Allergy and Infectious Diseases of the National Institutes of Health under award number K23AI121325. This project is also supported in part by the Health Resources and Services Administration (HRSA), Maternal and Child Health Bureau, and Emergency Medical Services for Children Network Development Demonstration Program under cooperative agreements U03MC00008, U03MC00001, U03MC00003, U03MC00006, U03MC00007, U03MC22684, and U03MC22685. Disclosure: O.R. reports personal fees from HuMabs, Abbvie, Janssen, Medimmune, and Regeneron, and grants from Janssen. All these fees and grants are not related to the current work. All remaining authors report no conflict of interest. Disclaimer: This information or content and conclusions are those of the author and should not be construed as the official position or policy of, nor should any endorsements be inferred by HRSA, HHS, or the US government. The funding organizations had no role in the design and conduct of the study; collection, management, analysis, and interpretation of the data; preparation, review, or approval of the manuscript; and decision to submit the manuscript for publication. Reprints: Todd A Florin, MD, MSCE, Division of Emergency Medicine Ann and Robert H. Lurie Children's Hospital of Chicago 225 E Chiago Avenue, Box 62 Chicago, IL 60611 (e–mail: [email protected]). Supplemental digital content is available for this article. Direct URL citations appear in the printed text and are provided in the HTML and PDF versions of this article on the journal’s Web site (www.pec-online.com). Copyright © 2020 Wolters Kluwer Health, Inc. All rights reserved. ISSN: 0749-5161 Study Design: We conducted a planned secondary analysis of a prospective cohort study within 26 emergency departments in a pediatric research network from 2008 to 2013. Febrile (≥38°C) infants 60 days or younger who received chest radiographs were included. Chest radiograph reports were categorized as “no,” “possible,” or “definite” pneumonia. We compared demographics, Yale Observation Scale scores (>10 implying ill appearance), laboratory markers, blood cultures, and viral testing among groups. Results: Of 4778 infants, 1724 (36.1%) had chest radiographs performed; 2.7% (n = 46) had definite pneumonias, and 3.9% (n = 67) had possible pneumonias. Patients with definite (13/46 [28.3%]) or possible (15/67 [22.7%]) pneumonias more frequently had Yale Observation Scale score >10 compared with those without pneumonias (210/1611 [13.2%], P = 0.002) in univariable and multivariable analyses. Median white blood cell count (WBC), absolute neutrophil count (ANC), and procalcitonin (PCT) were higher in the definite (WBC, 11.5 [interquartile range, 9.8–15.5]; ANC, 5.0 [3.2–7.6]; PCT, 0.4 [0.2–2.1]) versus no pneumonia (WBC, 10.0 [7.6–13.3]; ANC, 3.4 [2.1–5.4]; PCT, 0.2 [0.2–0.3]; WBC, P = 0.006; ANC, P =0.002; PCT, P = 0.046) groups, but of unclear clinical significance. There were no cases of bacteremia in the definite pneumonia group. Viral infections were more frequent in groups with definite (25/38 [65.8%]) and possible (28/55 [50.9%]) pneumonias than no pneumonias (534/1185 [45.1%], P = 0.02). Conclusions: Radiographic pneumonias were uncommon, often had viruses detected, and were associated with ill appearance, but few other predictors, in febrile infants 60 days or younger.
Keywords
- chest radiography
- fever
- infants
- pneumonia
ASJC Scopus subject areas
- Pediatrics, Perinatology, and Child Health
- Emergency Medicine