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Clinical Evaluation of Diagnostic Criteria for Early Prediction of Bacterial Infection in Febrile Neonates

Journal of the Korean Pediatric Society 1999;42(12):1661-1667.
Published online December 15, 1999.
Clinical Evaluation of Diagnostic Criteria for Early Prediction of Bacterial Infection in Febrile Neonates
Jai Il Cho, Sang Chun Lee, Hwan Il Kim, Cheol Am Kim, Kil Seo Kim
Department of Pediatrics, Dae Dong Hospital, Pusan, Korea
발열 신생아에서 세균성 감염의 조기 예측을 위한 진단 기준의 임상적 평가
조재일, 이상춘, 김환일, 김철암, 김길서
부산 대동병원 소아과
Jai Il Cho, Email: 1
: A retrospective study was undertaken to test the hypothesis that febrile neonates, who have bacterial infections, can be accurately predicted early by diagnostic criteria.
: We conducted a retrospective study of 152 infants, 28 days or less of age, whose rectal temperature was at least 38℃. Past history, family history, finding on physical examinations and results of CBC, urinalysis, lumbar puncture, CRP, and cultures of blood, urine and CSF were recorded. The diagnostic criteria for bacterial infection were : presence of identifiable fever focus(skin, soft tissue, bone, joint, eyes, ears), presence of maternal risk factors(malnutrition, fever, infection, premature rupture of membrane) & neonatal risk factors(prematurity, SGA), unhealthy condition at physical examinations, neutrophil index(immature neutrophil count/total neutrophil count ratio)≥0.15 and CRP≥2.0mg/dL, urinalysis-≥5 WBC/high-power field, absence of upper respiratory tract illness in parent and contact people. Febrile neonates who meet any of the diagnostic criteria were considered as high risk for bacterial infection.
: The overall incidence of bacterial infections in the 152 febrile neonates was 13.8%(21 neonates) with urinary tract infections in 8 neonates, bacteremia in 8 neonates and meningitis in 5 neonates. Only 1 neonate, who was classified as low risk for bacterial infection, was identified with a bacterial urinary tract infection. The sensitivity, specificity, positive predictive value and negative predictive value of the diagnostic criteria were 95.2, 92.4, 66.7 and 99.2%, respectively.
: These data show the ability of diagnostic criteria to identify neonates with bacterial infection. Febrile neonates who meet the diagnostic criteria must be treated intensively and those who do not meet the diagnostic criteria can be carefully managed as inpatients or outpatients without administering antimicrobial agents, avoiding iatrogenic complications.
Key Words: Febrile neonates, Bacterial infection, Early prediction, Diagnostic criteria

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