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

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
김소현1, 정지아2, 김혜순1, 유은선1, 손세정1, 서정완1, 이승주1
1이화여자대학교 의과대학 소아과학교실
2분당제생병원 소아과
Hae-Soon Kim, Email: hyesk@ewha.ac.kr
: 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.
: 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.
: 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.
: 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

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