Article Text

Download PDFPDF
Is it time to incorporate viral testing results within clinical practice guidelines for febrile infants?
  1. Nathan Money1,
  2. Sriram Ramgopal2
  1. 1 Department of Pediatrics, The University of Utah School of Medicine, Primary Children's Hospital, Salt Lake City, Utah, USA
  2. 2 Department of Pediatrics, Ann & Robert H Lurie Children's Hospital of Chicago, Chicago, Illinois, USA
  1. Correspondence to Dr Sriram Ramgopal, Ann and Robert H Lurie Children's Hospital of Chicago, Chicago, IL 60611, USA; sramgopal{at}

Statistics from

Request Permissions

If you wish to reuse any or all of this article please use the link below which will take you to the Copyright Clearance Center’s RightsLink service. You will be able to get a quick price and instant permission to reuse the content in many different ways.

The prevalence of bacteraemia and bacterial meningitis (commonly referred to as invasive bacterial infections or IBIs) among febrile infants informs ED clinician management decisions about the need for testing, treatment or hospitalisation. Using increasingly sophisticated risk stratification technologies, the management of these infants has evolved over time. Concurrently, the prevalence of IBI has decreased, largely due to vaccination and maternal antibiotic prophylaxis. The role of viral testing in medical decision-making for febrile infants is not clearly established. Prior work has suggested that febrile infants with viral infections may be at a lower risk of IBI; however, these studies are from a time when respiratory viral testing was inconsistently performed.1 The American Academy of Pediatrics’ clinical practice guideline does not state an explicit role for viral testing, leaving this an open question in need of further research.1 As the COVID-19 pandemic has resulted in increases in viral testing, researchers have greater opportunities to investigate how virus positivity impacts the risk of IBI in febrile infants.

In their meta-analysis published in EMJ,2 Pérez-Porra and colleagues describe the prevalence of IBI among febrile infants in the ED who were positive for COVID-19 infection using data from 33 prospective studies, retrospective studies and case series. The investigators identified an …

View Full Text


  • Handling editor Gene Yong-Kwang Ong

  • Contributors NM and SR contributed to the conception of the work and drafting it. Both authors provide final approval of the version to be published and agree to be accountable for all aspects of the work in ensuring that questions related to the accuracy or integrity of any part of the work are appropriately investigated and resolved.

  • Funding SR is funded by the Gerber Foundation (grant #9940).

  • Competing interests None declared.

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

Linked Articles