Management of Hospitalized Febrile Neonates Without CSF Analysis: A Study of US Pediatric Hospitals.
Management of Hospitalized Febrile Neonates Without CSF Analysis: A Study of US Pediatric Hospitals.
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DOI：
10.1542/hpeds.2014-0175
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发表时间：
2015-10-01
影响因子：
--
通讯作者：
Shah, Neha
中科院分区：
文献类型：
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作者：
Bhansali, Priti;Wiedermann, Bernhard L;Shah, Neha
目的：发热新生儿的管理包括获得血液、尿液和脑脊液（CSF）培养，并住院进行经验性肠外抗生素治疗。结果和新生儿的管理进行了比较的基础上是否获得CSF.METHODS：2002年至2012年儿科健康信息系统数据库的多中心回顾性审查包括住院婴儿年龄≤ 28天（新生儿）入院的住院病房与发热或新生儿发热的诊断代码。排除入住ICU或具有复杂慢性疾病诊断代码的患者。新生儿被归类为完整的败血症检查（FSW;收费代码的血液，尿液和脑脊液培养或细胞计数）或部分败血症检查（PSW;收费代码的血液和尿液培养只），他们的数据进行了比较。结果：27480新生儿诊断代码为发热，14774进行了FSW和3254有PSW。两组的中位住院时间均为2天，在再入院、处置或肠外抗生素给药方面无显著差异。新生儿与PSW有显着更大的几率有额外的实验室检查和成像的收费代码，他们更有可能收到败血症，脑膜炎，或bronchiolitis.CONCLUSIONS的诊断代码：新生儿与PSW的住院时间和再入院率与FSW相似，但更有可能接受额外的实验室检查和成像。未来的研究，包括有关临床严重程度和测试结果的信息，可能会提供更多的洞察力，在实践中的变化，为这一患者群体。
OBJECTIVE: Management of febrile neonates includes obtaining blood, urine, and cerebrospinal fluid (CSF) cultures with hospitalization for empiric parenteral antibiotic therapy. Outcomes and management for neonates were compared based on whether CSF was obtained.METHODS: This multicenter retrospective review of the 2002 to 2012 Pediatric Health Information System database included hospitalized infants aged ≤28 days (neonates) admitted to an inpatient ward with a diagnosis code for fever or neonatal fever. Patients admitted to an ICU or with a complex chronic condition diagnosis code were excluded. Neonates were categorized as full septic workup (FSW; charge codes for blood, urine, and CSF culture or cell count) or as partial septic workup (PSW; charge codes for blood and urine cultures only), and their data were compared.RESULTS: Of 27480 neonates with a diagnosis code for fever, 14774 underwent the FSW and 3254 had a PSW. Median length of stay was 2 days for both groups, with no significant difference in readmissions, disposition, or parenteral antibiotic administration. Neonates with a PSW had significantly greater odds of having charge codes for additional laboratory testing and imaging, and they were more likely to receive a diagnosis code for sepsis, meningitis, or bronchiolitis.CONCLUSIONS: Neonates with PSW had lengths of stay and readmission rates similar to those with FSW but were more likely to undergo additional laboratory testing and imaging. Future studies including information about clinical severity and test results may provide additional insight into the variation in practice for this patient population.