Resident Physician The Barbara Bush Children's Hospital at Maine Medical Center South Portland, Maine, United States
Background: Protocols for evaluating febrile infants are crucial to detect and treat invasive bacterial infections (IBI). If initial work-up is reassuring, fever is often attributed to a viral cause. Globally, viral illness incidence declined during the COVID-19 pandemic due to social distancing/masking, but limited research exists on IBI in infants. One study found a decrease in absolute numbers of febrile infants evaluated during the pandemic compared to pre-COVID-19 but a higher proportion of IBI. Objective: Our primary aim was to characterize febrile infants evaluated at our hospital prior to the COVID-19 pandemic, at the height of the US pandemic, and after social distancing/masking relaxation. Our secondary aim was to compare characteristics across these 3 periods. Design/Methods: We conducted a retrospective observational study of febrile infants 8-60 days old evaluated at our site between 7/1/2018 and 12/31/22. We compared infants evaluated pre-pandemic (7/1/2018-3/31/2020), early-pandemic (4/1/2020-6/30/2021), and later-pandemic (7/1/2021-12/31/2022). Differences in age, clinical appearance, and IBI rates, sites, and organisms were assessed by Fisher’s Exact and Chi-squared tests. Results: 251 febrile infants aged 8-60 days were evaluated: 105 pre-pandemic, 25 early-pandemic, and 121 later-pandemic. Pre-pandemic, 83% of infants were well-appearing, while 84% and 72% were well-appearing in the early- and later-pandemic periods, respectively. The proportion of younger infants (8-21 days old) was 27% pre-pandemic and 24% for both pandemic periods. The highest proportion of IBI was in the early pandemic (16%) compared to pre- (7%) and later-pandemic (6%). Urine was the most common infection source in the pre- and later-pandemic periods (6%, 12%), while blood and urine sources were equally common in the early-pandemic period (12% both). E coli was most commonly-isolated organism across all periods, with group B streptococcus isolated at the same rate as E. coli in the early pandemic. No comparisons among time periods were statistically significant.
Conclusion(s): The number of febrile infants presenting to our site declined during the early pandemic with return to near pre-pandemic levels by Fall 2021. While fewer infants were seen, the absolute number of IBIs was relatively stable, thus the proportion of febrile infants with IBI was higher during the early pandemic. A smaller proportion of infants were well appearing late-pandemic. However, these results were not statistically significant. Further research is needed to determine if providers need a higher suspicion for IBI during abnormal respiratory seasons.
.png)
