Emergency room physicians may soon have a new protocol for diagnosing life-threatening bacterial infections among feverish infants up to 2 months of age. This would likely eliminate the need to perform spinal taps, administer unnecessary antibiotics and/or costly hospital stays. Researchers from the Pediatric Emergency Care Applied Research Network (PECARN) developed the protocol from a study of more than 1,800 infants at 26 ERs around the U.S. The findings appear in JAMA Pediatrics.
Previous studies suggest that 8 to 13 percent of infants up to 2 months of age who have a fever may have a serious bacterial infection (SBI) such as urinary tract infections, bacteremia and bacterial meningitis, which often requires a spinal tap (lumbar puncture to extract fluid from the spinal canal) to confirm a diagnosis. Complications from the procedure are rare but can include inflammation of the spinal canal, bleeding and headache. The newer method measures the levels of bacteria in urine called procalcitonin (a substance produced in response to bacterial infection) in serum, and of neutrophils, an infection-fighting white blood cell. Low levels of these along with a normal neutrophil count led researchers to rule out an SBI. Further study is needed before the protocol can be applied to medical practice.
