Outcome of Febrile Infants ≤3 Months of Age Admitted to the Emergency Department of a Belgian Tertiary Pediatric Hospital

Abstract

Background: Fever in infants less than 3 months old is a common reason for pediatric emergency department visits, most children presenting fever without source, and they often undergo several medical examinations to exclude a bacterial infection (BI), frequently requiring hospitalization. This study sought to document fever outcomes in newborns and infants under 3 months old, based on hospitalization data, to find a prediction rule enabling healthcare professionals to identify febrile infants at risk for BI.

Methods: We conducted a single-center retrospective study covering a period from January 2016 to December 2022. Overall, 150 infants aged up to 3 months old were admitted for fever without source at Cliniques universitaires Saint-Luc emergency department, Brussels, Belgium. We analyzed the patient’s medical history, clinical presentation, and complementary test results to identify predictors of BI.

Results: Among test results, we noted a significant increase in C-reactive protein levels (CRP=12.8mg/L in BI cases; 5.5mg/L in viral infection cases, p-value=0.04) and neutrophil numbers in BI cases in children under 4 weeks old. No anamnestic or clinical factors could effectively differentiate febrile children aged less than 3 months at risk of developing BI.

Conclusion: Further investigations are required to identify infants at risk for BI using new biological parameters, including procalcitonin dosage. The management protocol of these children must be re-evaluated to assess the complementary tests to be performed, whether hospitalization would be required and, if so, which patients are eligible for hospital admission.