Although rates of bacterial meningitis are low among neonates and infants, researchers estimated that febrile children in the first month of life are at nearly twice the risk for having bacterial meningitis compared with febrile children aged older than 1 month, according to a meta-analysis published in JAMA Network Open
“Fever in infants has been, and remains, a common clinical conundrum for health care providers,” Eric A. Biondi, MD, director of the division of hospital medicine at Johns Hopkins, told Infectious Diseases in Children. “Age younger than 30 days is often used as a cut-off for obtaining a lumbar puncture and hospitalizing the infant for 36 to 48 hours because it has been presumed that infants in this age group are at higher risk for bacteremia and bacterial meningitis than infants aged older than 30 days.”
Biondi and colleagues conducted a systematic review and meta-analysis that included 15,713 culture findings and results from 12 studies. They found that the prevalence of bacteremia (2.9% vs. 1.6%) and bacterial meningitis (1.2% vs. 0.4%) was were both higher among febrile neonates compared with febrile infants.
“Our data suggest that the risk of bacteremia and/or bacterial meningitis may be statistically higher in these younger infants, but from the perspective of absolute risk, the difference is less than 1.5%,” Biondi said.
The researchers also estimated the prevalence of bacteremia and bacterial meningitis among febrile neonates after 1996, marking the beginning of the era of group B Streptococcus (GBS) intrapartum antibiotic prophylaxis — which was 3% and 1%, respectively.
“Our pooled prevalence estimate of the rate of bacterial meningitis in febrile neonates in the era after GBS prophylaxis was 1%, whereas the estimate in febrile infants in the second month of life was 0.4%,” the researchers wrote. “Although this outcome is roughly twice the rate of meningitis in the younger age group, it is unclear whether such a difference in pretest probability obviates the need to perform a lumbar puncture in older infants.”
Biondi stressed that health care providers should base their treatment decisions on factors associated with their own risk tolerances, “including things like primary care provider follow-up, family transportation and other factors.”
“Our data provide fairly robust prevalence estimates that can now be used in determining the risk for bacterial infection in a given infant with fever,” she added. – by Katherine Bortz
Disclosures: Biondi reports receiving personal fees as a consultant for McKesson Inc. Please see the study for all other authors’ relevant financial disclosures.