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A Clinical Study of Hospitalized Neonates with Fever.

Journal of the Korean Pediatric Society 1988;31(11):1437-1444.
Published online November 30, 1988.
A Clinical Study of Hospitalized Neonates with Fever.
Youn Mo Ahn, Chang Ryul Kim, Woo Gill Lee, Soo Jee Moon
Department of Pediatrics, Hanyang University College of Medicine, Seoul, Korea
열을 주소로 입원한 신생아에 대한 임상적 관찰
안연모, 김창렬, 이우길, 문수지
한양대학교 의과대학 소아과학교실
Received: 28 March 1988   • Accepted: 11 July 1988
Life-threatening bacterial infections such as meningitis, septicemia, and pneumonia in the neonates are more common than at any other time in life and signs of these infections are often subtle and non-specific. Because of these factors, the patient who has persistent fever will almost always be started on parenteral antibiotics immediately following evaluation. On the other hand there is also evidence that the hospital course of most febrile infants seemed benign and pre-antibiotic cultures were usually negative. Therefore the physicians for infants and children are faced with the task of separating patients with a inconsequential infection from these serious infections amenable to antimicrobial therapy. We studied clinically 136 neonates with fever defined as axillary temperature of 37.5'C or more, who were hospitalized in the Department of Pediatrics Hanyang University Hospital through out- patient clinic or emergency room from April 1984 to March 1987 to get the prevalence and probability of these serious bacterial diseases and obtained the following results. 1) 136 neonates with fever represented 1.4 per cent of all pediatric patients admission and 26 per cent of neonates admission. 2) 55 per cent of neonates with fever were less than 1 week of age and approximately 70 per cent less than 2 weeks of age. 3) 60 per cent of febrile neonates were boys and male to female ratio was 1.5 : 1. 4) The highest prevalence of febrile neonates was noted in the summer (41%) and lowest in the spring (14%)(p<0.05). 5) Final diagnoses of febrile neonates at discharge were as follows; urinary tract infection (19%), septicemia (18%), pneumonia (13%) and so on. If the septicemia included the septicemia diagnosed not by bacteriologically but by clinically and patients with two more diagnoses were classified according to the more serious disease entity, final diagnoses at discharge were in the following order; septicemia (or bacteremia) 36 per cent, urinary tract infection 20 per cent, pneumonia (with/without bacteremia) 15 per cent, dehydration 6 per cent, gastrointestinal diseases 6 per cent, meningitis (with/without bacteremia) 5 per cent. Approximately 90 per cent of febrile neonates have had severe infectious diseases and 5 per cent of neonates with fever had no diagnoseable illness. 6) Of 136 blood cultures, 31 per cent yielded a pathogen; coagulase negative Staphylococcus (59%), Escherichia coli (11%), Staphylococcus aureus (7%), and Enterococcus (7%). Urine cultures were positive in 43 per cent of 87 neonates with fever. Escherichia coli was identified frequently (32%); Enterococcus ranked next (26%); Klebsiella (15%) and Staphylococcus aureus (11%) followed. Positive umbilical cultures were found in 50 cases among 51 febrile neonates. Most of them had multiple bacterial growths. Prevalence were as follows; Staphylococcus aureus (26%), Escherichia coli (17%), Enterococcus (10%), Pseudomonas (10%), Klebsiella (10%), and Enterobacter (9%). 7) Compared the interrelationship between organisms isolated from blood, urine, and umbilical cultures in order to determine the route of infection in neonates with fever, no specific conclusion could be obtained. 8) 86 per cent of neonates with fever were discharged with improvement, 15 cases were discharged against advice and 2 cases died. Over-all mortality was 11 per cent if 13 cases discharged hopelessly were regarded as dead. Causes of death were neonatal tetanus, meningitis, septicemia, and pneumo- nia. 9) Our findings suggest that neonates should be evaluated and treated with antibiotics when they have fever at out-patient clinic or emergency room.
Key Words: Fever, Infections, Neonates

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