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  • Radiographic pneumonia in young febrile infants presenting to the emergency department: secondary analysis of a prospective cohort study

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Original research
Radiographic pneumonia in young febrile infants presenting to the emergency department: secondary analysis of a prospective cohort study
  1. Todd A Florin1,2,
  2. Octavio Ramilo3,
  3. Russell K Banks4,
  4. David Schnadower5,
  5. Kimberly S Quayle6,
  6. Elizabeth C Powell1,2,
  7. Michelle L Pickett7,
  8. Lise E Nigrovic8,
  9. Rakesh Mistry9,
  10. Aaron N Leetch10,
  11. Robert W Hickey11,
  12. Eric W Glissmeyer4,
  13. Peter S Dayan12,
  14. Andrea T Cruz13,
  15. Daniel M Cohen3,
  16. Amanda Bogie14,
  17. Fran Balamuth15,
  18. Shireen M Atabaki16,17,
  19. John M VanBuren4,
  20. Prashant Mahajan18,
  21. Nathan Kuppermann19
  22. for the Febrile Infant Working Group of the Pediatric Emergency Care Applied Research Network (PECARN)
  1. 1 Department of Pediatrics, Ann and Robert H Lurie Children's Hospital of Chicago, Chicago, Illinois, USA
  2. 2 Pediatrics, Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA
  3. 3 Department of Pediatrics, Nationwide Children's Hospital, Columbus, Ohio, USA
  4. 4 Department of Pediatrics, University of Utah Medical Center, Salt Lake City, Utah, USA
  5. 5 Department of Pediatrics, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio, USA
  6. 6 Department of Pediatrics, Washington University School of Medicine in Saint Louis, St Louis, Missouri, USA
  7. 7 Department of Pediatrics, Medical College of Wisconsin, Milwaukee, Wisconsin, USA
  8. 8 Department of Medicine, Boston Children's Hospital, Boston, Massachusetts, USA
  9. 9 Department of Pediatrics, Children's Hospital Colorado, Aurora, Colorado, USA
  10. 10 Departments of Emergency Medicine and Pediatrics, University of Arizona Medical Center—Diamond Children's, Tucson, Arizona, USA
  11. 11 Department of Pediatrics, University of Pittsburgh Medical Center Health System, Pittsburgh, Pennsylvania, USA
  12. 12 Emergency Medicine, Division of Pediatric Emergency Medicine, Columbia University College of Physicians and Surgeons, New York, New York, USA
  13. 13 Pediatrics, Texas Children's Hospital, Houston, Texas, USA
  14. 14 Department of Pediatrics, The University of Oklahoma College of Medicine, Oklahoma City, Oklahoma, USA
  15. 15 Department of Pediatrics, The Children's Hospital of Philadelphia, Philadelphia, Pennsylvania, USA
  16. 16 Emergency Medicine, Children's National Health System, Washington, District of Columbia, USA
  17. 17 Department of Pediatrics, Children's National Health System, Washington, District of Columbia, USA
  18. 18 Department of Emergency Medicine, University of Michigan, Ann Arbor, Michigan, USA
  19. 19 Departments of Emergency Medicine and Pediatrics, University of California, Davis School of Medicine, Sacramento, California, USA
  1. Correspondence to Dr Todd A Florin, Department of Pediatrics, Ann and Robert H Lurie Children's Hospital of Chicago, Chicago, IL 60611, USA; taflorin{at}luriechildrens.org

Abstract

Objective The lack of evidence-based criteria to guide chest radiograph (CXR) use in young febrile infants results in variation in its use with resultant suboptimal quality of care. We sought to describe the features associated with radiographic pneumonias in young febrile infants.

Study design Secondary analysis of a prospective cohort study in 18 emergency departments (EDs) in the Pediatric Emergency Care Applied Research Network from 2016 to 2019. Febrile (≥38°C) infants aged ≤60 days who received CXRs were included. CXR reports were categorised as ‘no’, ‘possible’ or ‘definite’ pneumonia. We compared demographics, clinical signs and laboratory tests among infants with and without pneumonias.

Results Of 2612 infants, 568 (21.7%) had CXRs performed; 19 (3.3%) had definite and 34 (6%) had possible pneumonias. Patients with definite (4/19, 21.1%) or possible (11/34, 32.4%) pneumonias more frequently presented with respiratory distress compared with those without (77/515, 15.0%) pneumonias (adjusted OR 2.17; 95% CI 1.04 to 4.51). There were no differences in temperature or HR in infants with and without radiographic pneumonias. The median serum procalcitonin (PCT) level was higher in the definite (0.7 ng/mL (IQR 0.1, 1.5)) vs no pneumonia (0.1 ng/mL (IQR 0.1, 0.3)) groups, as was the median absolute neutrophil count (ANC) (definite, 5.8 K/mcL (IQR 3.9, 6.9) vs no pneumonia, 3.1 K/mcL (IQR 1.9, 5.3)). No infants with pneumonia had bacteraemia. Viral detection was frequent (no pneumonia (309/422, 73.2%), definite pneumonia (11/16, 68.8%), possible pneumonia (25/29, 86.2%)). Respiratory syncytial virus was the predominant pathogen in the pneumonia groups and rhinovirus in infants without pneumonias.

Conclusions Radiographic pneumonias were uncommon in febrile infants. Viral detection was common. Pneumonia was associated with respiratory distress, but few other factors. Although ANC and PCT levels were elevated in infants with definite pneumonias, further work is necessary to evaluate the role of blood biomarkers in infant pneumonias.

  • pneumonia
  • emergency department
  • respiratory
  • infections

Data availability statement

No data are available.

https://doi.org/10.1136/emermed-2023-213089

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    Data availability statement

    No data are available.

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    Footnotes

    • Handling editor Gene Yong-Kwang Ong

    • Twitter @toddflorin1

    • Collaborators Febrile Infant Working Group of the Pediatric Emergency Care Applied Research Network (PECARN), which includes all authors, in addition to Melissa Vitale, MD (University of Pittsburgh School of Medicine), Leah Tzimenatos, MD (University of California Davis School of Medicine), Richard M Ruddy, MD (Cincinnati Children’s Hospital Medical Center),Grace Park, DO, MPH (University of New Mexico School of Medicine); Angela Ellison,MD, MSCE (Children’s Hospital of Philadelphia) and Allison Cator, MD (University of Michigan School of Medicine).

    • Contributors Study concept and design: TAF, JMVB, OR, PM, NK. Acquisition of the data: TAF, OR, RKB, DS, KSQ, ECP, MLP, LEN, RM, ANL, RWH, EWG, PSD, ATC, DMC, AB, FB, SMA, JMVB, PM, NK. Analysis and interpretation of the data: TAF, OR, RKB, DS, KSQ, ECP, MLP, LEN, RM, ANL, RWH, EWG, PSD, ATC, DMC, AB, FB, SMA, JMVB, PM, NK. Drafting of the manuscript: TAF, RKB, JMVB, PM, OR, NK. Critical revision of the manuscript for important intellectual content: TAF, OR, RKB, DS, KSQ, ECP, MLP, LEN, RM, ANL, RWH, EWG, PSD, ATC, DMC, AB, FB, SMA, JMVB, PM, NK. Statistical expertise: JVB, RKB. Acquisition of funding: OR, PM, NK. Guarantor: TAF

    • Funding This study was supported in part by the Eunice Kennedy Shriver National Institute of Child Health and Human Development of the National Institutes of Health (R01HD085233). This project was also supported in part by the Health Resources and Services Administration, Maternal and Child Health Bureau, Emergency Medical Services for Children Network Development Demonstration Programme under cooperative agreements U03MC00008, U03MC00001, U03MC00003, U03MC00006, U03MC00007, U03MC22684 and U03MC22685. TAF’s effort was supported in part by the National Institute of Allergy and Infectious Diseases of the National Institutes of Health (K23AI121325 and R03AI147112) and National Heart, Lung, and Blood Institute (R34HL153474).

    • Competing interests OR reports personal fees from Sanofi-Pasteur, Merck and Pfizer, and grants from Janssen and the Bill & Melinda Gates Foundation. These fees and grants are not related to this study. No other disclosures were reported.

    • Patient and public involvement Patients and/or the public were not involved in the design, or conduct, or reporting, or dissemination plans of this research.

    • Provenance and peer review Not commissioned; externally peer reviewed.

    • Supplemental material This content has been supplied by the author(s). It has not been vetted by BMJ Publishing Group Limited (BMJ) and may not have been peer-reviewed. Any opinions or recommendations discussed are solely those of the author(s) and are not endorsed by BMJ. BMJ disclaims all liability and responsibility arising from any reliance placed on the content. Where the content includes any translated material, BMJ does not warrant the accuracy and reliability of the translations (including but not limited to local regulations, clinical guidelines, terminology, drug names and drug dosages), and is not responsible for any error and/or omissions arising from translation and adaptation or otherwise.