Resumen

DIAZ ALVAREZ, Manuel; BENITZ, William E.; MARTINEZ CANALEJO, Humberto  y  MORENO VAZQUEZ, Olimpo. Validation of criteria about low risk of severe bacterial infection in febrile newborns . Rev Cubana Pediatr [online]. 2007, vol.79, n.3. ISSN 0034-7531.

Criteria for prediction of low risk for serious bacterial infection (SBI) in febrile infants are imperfect, particularly in infants younger than 1 month. We sought to validate new criteria for evaluation of febrile neonates. To this end, 288 febrile newborns with complete evaluation for sepsis were prospectively classified as low-risk for infection if they looked well; had been previously healthy; had no signs of focal infection; did not have persistent, recurrent, or high fever 39.0C); and leukocyte counts of 520 x 109/liter, erythrocyte sedimentation rate <20 mm/hr; and <10,000 leukocytes/ml of urine. These criteria were compared to Rochester criteria and false-positive and false-negative rates were compared by Z-tests. SBI was present in 68 (23.6%) and bacteremia in 22 infants (7.6%). Only 5 of 68 (one with bacteremia) of these infants were classified as low risk using the new criteria (false-negative rate=7.3%, 95% CI (4.711.7%) whereas 15 of 68 (3 with bacteremia) were classified as low risk using the Rochester criteria (false-negative rate=22.0%, 95% CI (17.527.4%); P=0.03 vs. new criteria). The lowest false-negative rate was offset by a higher false-positive rate (65.9% vs. 37.7%).  The new criteria identifying low risk for serious bacterial infection in febrile neonates had a significantly lower false-negative rate than that of the classic Rochester criteria. These new criteria may facilitate adequate care of infants under 1 month of age who present with a history of fever.

Palabras clave : Bacterial infection; fever; bacteremia; neonate; risk evaluation.

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