Pediatrics Resident Nationwide Children's Hospital Nationwide Children's Hospital Columbus, Ohio, United States
Background: Infants commonly present to the emergency department (ED) for fever, hypothermia or other markers of infection. Infants are at high risk for serious bacterial illness (SBI) and adverse outcomes; thus, a low threshold for full evaluation, hospitalization and empiric antibiotics exists. However, given the incidence of SBI is only 8-13%, most well appearing infants will have an uneventful hospitalization without requiring an escalation in care. However, limited studies describe the hospital course of these infants.
Objective: Our study provides a descriptive analysis of the outcomes and need for escalation in care in well appearing infants admitted for evaluation for SBI.
Design/Methods: A retrospective chart review was performed on all infants 0-28 days admitted from our ED to the floor for evaluation of SBI between 2009-2019. Infants with prematurity, signs of localized infections (ie. Cellulitis), or significant comorbidities were excluded. The remaining cohort of infants' hospital charts were reviewed for escalation of care, including intravenous fluid boluses, supplemental oxygen, transfer to the Intensive Care Unit (ICU), extended length of stay beyond 72 hours, or readmission within 72 hours of discharge. Infants were also assessed for presence or absence of SBI and correlation with need for escalation of care.
Results: Out of 2136 infants initially screened, 607 were excluded. Of the 1529 infants included approximately 29% (456 infants) required an escalation of care, 58% had length of stay >72 hours, 41% required supplemental fluids, 37% required supplemental oxygen, 11% required transfer to the ICU, and 2% were readmitted within 72 hours. 54% of the infants requiring an escalation of care had an SBI (defined as urinary tract infection, bacteremia or, meningitis), with urinary tract infect being the most common. All included infants in the study survived. Conclusion(s): This descriptive analysis shows that a significant proportion of well appearing infants 0-28 days admitted to the floor for evaluation of SBI required an escalation of care during their hospital course. Thus while there are risks and costs associated with hospitalization, this population of infants remains vulnerable and at high risk. Ultimately, hospitalization of these infants for a minimum period of observation is supported. Further research will be useful in elucidating risk factors for escalation of care and defining the period of observation.
Authors/Institutions: Keerthi Channarasappa, Nationwide Children's Hospital, Columbus, Ohio, United States; Abha Athale, Nationwide Children's Hospital, Columbus, Ohio, United States; Maegan Reynolds, Nationwide Children's Hospital, Columbus, Ohio, United States