Performance of AAP CPG for Ineligible Well-Appearing Febrile Infants Aged 8–60 Days

This is the authors' abstract. We don't add key points for this paper.

BACKGROUND AND OBJECTIVES: The AAP's Clinical Practice Guidelines (CPG) for febrile infants provides recommendations in evaluating well-appearing febrile infants aged 8-60 days at risk for invasive bacterial infections (IBIs; ie, bacteremia and bacterial meningitis). However, guidance remains limited for the infants excluded from (ie, ineligible for) the CPG. The objectives are to estimate the proportion of well-appearing CPG-ineligible febrile infants and to examine CPG performance in detecting IBIs for CPG-ineligible febrile infants. METHODS: We performed a secondary analysis of single-site data collected for a prior study from 2011 to 2018. Infants were included if they were 8-60 days and well-appearing. We stratified IBI risk using age and CPG inflammatory marker thresholds for temperature, absolute neutrophil count, and C-reactive protein. We conducted analyses on CPG-ineligible infants and CPG-eligible infants. We estimated the areas under the receiver operating characteristics curve, sensitivity, and specificity of both approaches in detecting IBIs. RESULTS: Of 648 infants, 22% did not meet CPG eligibility. Sensitivities for both analyses were 100% with specificities for CPG-ineligible and eligible of 38.1% (95% CI, 30-47) and 38.2% (95% CI, 33.9-42.6), respectively. CONCLUSIONS: Strict adherence to the CPG may result in a substantial proportion of ineligible infants. Findings suggest that CPG-based approaches can maintain high sensitivities for all febrile infants, including CPG-ineligible infants. Future studies should examine the contribution of specific conditions (eg, preterm birth) to IBI risk.