Radiographic Pneumonia in Febrile Infants 60 Days and Younger.
Radiographic Pneumonia in Febrile Infants 60 Days and Younger.
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DOI：
10.1097/pec.0000000000002187
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发表时间：
2021-05-01
影响因子：
1.4
通讯作者：
Febrile Infant Working Group of the Pediatric Emergency Care Applied Research Network (PECARN)
中科院分区：
文献类型：
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作者：
Florin TA;Ramilo O;Hoyle JD Jr;Jaffe DM;Tzimenatos L;Atabaki SM;Cohen DM;VanBuren JM;Mahajan P;Kuppermann N;Febrile Infant Working Group of the Pediatric Emergency Care Applied Research Network (PECARN)
很少有前瞻性研究评估了年轻发热婴儿放射学肺炎的发生率。我们分析了在儿科急诊科（ED）评估的≤60天发热婴儿的放射学肺炎相关因素。计划对2008-2013年儿科研究网络中26个ED内的前瞻性队列研究进行二次分析。纳入接受胸部X线片（CXR）检查的≤60天发热（≥38 ℃）婴儿。CXR报告被分类为“无”、“可能”或“明确”肺炎。我们比较了各组的人口统计学、耶鲁观察量表评分[YOS; >10意味着外表不好]、实验室标志物、血培养和病毒检测。在4,778名婴儿中，1724名（36.1%）进行了CXR检查; 2.7%（n=46）有明确的肺炎，3.9%（n=67）可能有肺炎。在单变量和多变量分析中，与未发生肺炎的患者（210/1611，13.2%，p=0.002）相比，明确（13/46，28.3%）或可能（15/67，22.7%）肺炎患者的YOS >10更常见。中位白色血细胞计数（WBC）、中性粒细胞绝对计数（ANC）和降钙素原（PCT）在明确的[WBC 11.5（IQR 9.8，15.5）; ANC 5.0（3.2，7.6）; PCT 0.4（0.2，2.1）]与无肺炎[WBC 10.0（7.6，13.3）; ANC 3.4（2.1，5.4）; PCT 0.2（0.2，0.3）]（WBC p=0.006，ANC p=0.002，PCT p=0.046）组，但临床意义不明确。确诊肺炎组无菌血症病例。病毒感染在明确（25/38，65.8%）和可能（28/55，50.9%）肺炎组中的发生率高于无肺炎组（534/1185，45.1%，p=0.02）。在≤60日龄的发热婴儿中，放射学肺炎并不常见，常检出病毒，且与外观不良有关，但很少有其他预测因素。
Few prospective studies have assessed the occurrence of radiographic pneumonia in young febrile infants. We analyzed factors associated with radiographic pneumonias in febrile infants ≤60 days-old evaluated in pediatric emergency departments (EDs). Planned secondary analysis of a prospective cohort study within 26 EDs in a pediatric research network from 2008–2013. Febrile (≥38°C) infants ≤60-days-old who received chest radiographs (CXR) were included. CXR reports were categorized as “no,” “possible,” or “definite” pneumonia. We compared demographics, Yale Observation Scale scores [YOS; >10 implying ill appearance], laboratory markers, blood cultures and viral testing among groups. Of 4,778 infants, 1724 (36.1%) had CXRs performed; 2.7% (n=46) had definite pneumonias, and 3.9% (n=67) possible pneumonias. Patients with definite (13/46, 28.3%) or possible (15/67, 22.7%) pneumonias more frequently had YOS >10 compared to those without pneumonias (210/1611, 13.2%, p=0.002) in univariable and multivariable analyses. Median white blood cell count(WBC), absolute neutrophil count(ANC), and procalcitonin(PCT) were higher in the definite [WBC 11.5 (IQR 9.8,15.5); ANC 5.0 (3.2,7.6); PCT 0.4 (0.2,2.1)] versus no pneumonia [WBC 10.0 (7.6,13.3); ANC 3.4 (2.1,5.4); PCT 0.2 (0.2,0.3)] (WBC p=0.006, ANC p=0.002, PCT p=0.046) groups, but of unclear clinical significance. There were no cases of bacteremia in the definite pneumonia group. Viral infections were more frequent in groups with definite (25/38, 65.8%) and possible (28/55, 50.9%) pneumonias than no pneumonias (534/1185, 45.1%, p=0.02). Radiographic pneumonias were uncommon, often had viruses detected, and were associated with ill appearance, but few other predictors, in febrile infants ≤60-days-old.