EC Paediatrics

Objectives: The present study aims to evaluate the etiology and prognostic factors associated with fever in febrile neonates.

Methodology: The convenient sampling method was used for recruiting febrile neonates into our study. Full-term febrile neonates who were admitted to the neonatal ward and the neonatal intensive care unit (NICU) of our medical center between 2015 - 2017 were recruited to our study. Initial data including clinical data and demographic characteristics of the patients were recorded. A researcher-made checklist was used for collecting the demographic and clinical data of the neonates. The patients were followed up during admission until diagnosis was made. Data on the clinical characteristics of the neonates were analyzed descriptively, and the results were compared between groups.

Results: A total of 250 neonates were recruited into our study. Of these, 113 (45.2%) were females and 137 (54.8%) were males. The mean age of the neonates at the time of admission was 12.29 ± 9.1 days. The final diagnosis among our study population was as follows: Proven sepsis (4.4%); suspected sepsis (44.4%); clinical sepsis (9.6%); dehydration (28.8%) and other causes (12.8%). Logistic regression analysis was also used to determine the correlation between the variables and source of fever, and the results show that serum levels of BUN, sodium, and CRP can accurately predict the etiology of fever in full-term infants.

Conclusion: Majority of the febrile neonates were admitted in summer. We observed a significant correlation between the etiology of fever and the levels of BUN, sodium and CRP.

Keywords: Febrile Infants; Sepsis; Infection; Neonatal Fever

1. Greenhow TL., et al. “Management and Outcomes of Previously Healthy, Full-Term, Febrile Infants Ages 7 to 90 Days”. Pediatrics (2016): 138.
2. Huppler AR., et al. “Performance of low-risk criteria in the evaluation of young infants with fever: review of the literature”. Pediatrics2 (2010): 228-233.
3. Schwartz S., et al. “A week-by-week analysis of the low-risk criteria for serious bacterial infection in febrile neonates”. Archives of Disease in Childhood 4 (2009): 287-292.
4. Smitherman HF and Macias CG. Febrile infant (younger than 90 days of age): Definition of fever (2017).
5. Edwards MS., et al. “Group B streptococcal infections”. Remington JS, Klein JO, Wilson CB, Baker CJ, eds. Infectious Diseases of the Fetus and Newborn Infant. 6th edition. Philadelphia, Pa: Elsevier Saunders (2006).
6. Zachariassen G and Juvonen P. “Neonatal dehydrering (tørstefeber) hos nyfødte børn [Neonatal dehydration (dehydration fever) in newborn infants]”. Ugeskr Laeger 42 (2002): 4930-4934.
7. Kourtis AP., et al. “Practice Guidelines for the Management of Febrile Infants Less Than 90 Days of Age at the Ambulatory Network of a Large Pediatric Health Care System in the United States: Summary of New Evidence”. Clinical Pediatrics 43 (2004): 11-16.
8. Escobar GJ., et al. “Neonatal sepsis workups in infants >/=2000 grams at birth: A population-based study”. Pediatrics2-1 (2000): 256-263.
9. Baker MD and Avner JR. “The Febrile Infant: What's New?” Clinical Pediatric Emergency Medicine 4 (2008): 213-220.
10. Polin RA and the Committee on Fetus and Newborn. “Management of Neonates with Suspected or Proven Early-Onset Bacterial Sepsis”. Pediatrics5 (2012): 1006-1015.
11. Hamilton JL and John SP. “Evaluation of Fever in Infants and Young Children”. American Family Physician4 (2013): 254-260.
12. Vouloumanou EK., et al. “Serum procalcitonin as a diagnostic marker for neonatal sepsis: a systematic review and meta-analysis”. Intensive Care Medicine 5 (2011): 747-762.
13. Benitz WE. “Adjunct laboratory tests in the diagnosis of early-onset neonatal sepsis”. Clinics in Perinatology 2 (2010): 421-438.
14. Aronson PL., et al. “Evaluation of the Febrile Young Infant: An Update”. Pediatric Emergency Medicine Practice 2 (2013): 1-20.
15. Appleton RE and Foo CK. “Dehydration fever in the neonate: a common phenomenon”. Archives of Disease in Childhood 64 (1989): 765-766.
16. Singh M., et al. “Pathogenesis of so-called “dehydration fever” in the newborn”. Indian Pediatrics 12 (1975): 465-467.
17. Voora S., et al. “Fever in full-term newborns in the first four days of life”. Pediatrics 69 (1982): 40-44.
18. Maayan-Metzger A., et al. “Fever in healthy asymptomatic newborns during the first days of life”. Archives of Disease in Childhood. Fetal and Neonatal Edition 88 (2003): F312-F314.
19. Oddie S., et al. “Hypernatremic dehydration and breast-feeding: a population study”. Archives of Disease in Childhood 85 (2001): 318-320.
20. Manganaro R., et al. “Incidence of dehydration and hypernatremia in exclusively breast-fed infants”. The Journal of Pediatrics 139 (2001): 673-675.
21. Ng PC., et al. “Early onset of hypernatremic dehydration and fever in exclusively breast-fed infants”. Journal of Paediatrics and Child Health 35 (1999): 585-587.
22. Philip AGS and Hewitt JR. “Early diagnosis of neonatal sepsis”. Pediatrics 5 (1980): 1036-1041.