Usefulness of Low Risk Criteria for Serious Bacterial Infection
Among Febrile Infants Younger than Three Months of Age

Kim, So Hyun; Jung, Ji Ah; Kim, Hae-Soon; Yoo, Eun Sun; Sohn, Sejung; Seo, Jeong Wan; Lee, Seung Joo

Original Article

Journal of the Korean Pediatric Society 2002;45(8):967-972.
Published online August 15, 2002.

Usefulness of Low Risk Criteria for Serious Bacterial Infection Among Febrile Infants Younger than Three Months of Age

So Hyun Kim¹, Ji Ah Jung², Hae-Soon Kim¹, Eun Sun Yoo¹, Sejung Sohn¹, Jeong Wan Seo¹, Seung Joo Lee¹

¹Department of Pediatrics, College of Medicine, Ewha Womans University, Seoul, Korea
²Department of Pediatrics, Pundang Jesaeng General Hospital Daejin Medical Center, Sungnam, Korea

생후 3개월 이하의 발열이 있는 환아에서 세균성 감염의 예측을 위한 저위험 예측기준의 유용성

김소현^¹^, 정지아^²^, 김혜순^¹^, 유은선^¹^, 손세정^¹^, 서정완^¹^, 이승주^¹

^¹이화여자대학교 의과대학 소아과학교실
^²분당제생병원 소아과

Correspondence:
Hae-Soon Kim, Email: hyesk@ewha.ac.kr

Abstract

Purpose
: A retrospective study was undertaken to evaluate the usefulness of low risk criteria for identifying febrile infants younger than three months unlikely to have serious bacterial infection.
Methods
: We conducted a retrospective study of 527 infants younger than three month with a axillary temperature ≥37.4℃. If they met the following all four criteria, appear well, WBC 5,000- 20,000/mm3, urine stick WBC(－) and nitrite(－), CSF WBC <10/mm3, they were considered at low risk for serious bacterial infection(SBI). SBI was defined as a positive culture of urine, blood, or cerebrospinal fluid. The sensitivity, specificity, negative predictive value and positive predictive value of the low risk criteria were calculated.
Results
: Of 527 febrile infants, 110(21.0%) had serious bacterial infections. The 2.7% who met the low risk criteria had SBI and negative predictive value was 97.3%. SBI was diagnosed in 103 infants(38.6%) who didn't meet the low risk criteria including urinary tract infection(78.6%), most commonly, bacteremia(16.5%), bacterial meningitis(8.7%), Salmonella gastroenteritis(1%), osteomyelitis(1%), septic arthritis of hip joint(1%). There were no differences in the sensitivity and negative predictive value according to the monthly-age-group.
Conclusion
: This low risk criteria to identify infants unlikely to have SBI early is available, however low risk infants must be carefully observed.

Key Words: Fever without source, Febrile infant, Bacteremia, Low risk criteria, Predictive, Serious bacterial infection