Pediatricians and other pediatric clinicians who use individualized clinical judgment in treating infants with fevers can effectively diagnose serious illnesses and provide appropriate follow-up care, even when not following all the current clinical guidelines on how to manage such cases, according to a study in the March 10 issue of The Journal of the American Medical Association (JAMA).

According to background information in the article, infants with fevers (febrile infants) often lack the symptoms necessary for physicians to distinguish between a minor illness and one that is life-threatening. "To avoid the consequences of failing to detect serious bacterial illness (SBI), such as bacteremia (bacteria in the blood) and bacterial meningitis, a variety of clinical strategies have been developed to identify infants at high and low risk, including policies that require extensive laboratory testing, hospitalization, and treatment with intravenous antibiotics." The authors add that previous studies indicate that a large proportion of office-based physicians do not routinely follow these guidelines.

In this study, Robert H. Pantell, M.D., from the University of California, San Francisco and colleagues evaluated data from 3,066 infants aged 3 months or younger with temperatures of at least 38 degrees Celsius (100.4 degrees Fahrenheit) who were seen by physicians from February 28, 1995 through April 25, 1998. The 573 practitioners in the study were part of the Pediatric Research in Office Settings (PROS) network of the American Academy of Pediatrics in 44 states, the District of Columbia, and Puerto Rico.

"The PROS clinicians hospitalized 36 percent of the infants, performed laboratory testing in 75 percent, and initially treated 57 percent with antibiotics," the authors report. "The majority (64 percent) were treated exclusively outside of the hospital. [Bacteria in the blood] was detected in 1.8 percent of infants (2.4 percent of those te
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Contact: Carol Hyman
415-502-9553
JAMA and Archives Journals
9-Mar-2004

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