INCIDENCE OF SERIOUS BACTERIAL INFECTION IN FEBRILE NEONATES LESS THAN 28 DAYS WITH BRONCHIOLITIS
Bibliographic record
Abstract
BACKGROUND: Bronchiolitis is the most common reason for admission in infants under 12 months of age. There is uncertainty as to whether invasive tests to look for bacterial infections are necessary in febrile infants under 28 days of age who present with clinical findings consistent with bronchiolitis. OBJECTIVES: Several recent reviews suggest that babies 28 to 90 days of age with bronchiolitis are at relatively low risk of serious bacterial infection, with the exception of urinary tract infection (UTI). There has been no literature to date focusing exclusively on infants less than 28 days. DESIGN/METHODS: We conducted a multi-center retrospective chart review to determine the proportion of febrile infants less than 28 days of age admitted with bronchiolitis who were ultimately found to have a bacterial infection in their blood, urine, or cerebrospinal fluid. At each site all charts between March 2006 and May 2015 with an admission to hospital at age less than or equal to 28 days with a discharge diagnosis of bronchiolitis were reviewed. Exclusion criteria included lack of documented fever, gestational age at birth less than 36 weeks, known immunodeficiency, hemodynamically significant congenital heart disease, or congenital lung anomaly. RESULTS: Our sample included 226 neonates. There were 57 positive urine cultures, of which 34 were considered by the treating team to be contaminants, for a rate of UTI of 23 in 226, or 10.1%. Of the 23 UTIs, 16 had colony counts that were consistent with contamination based on the current CPS statement but which were treated as true infections. There were 6 positive blood cultures, of which 5 were considered to be contaminants, for a rate of bacteremia of 1 in 226. There were 2 positive cerebrospinal fluid (CSF) cultures. Both of the positive CSF cultures were considered to be contaminants, for a rate of meningitis of 0 in 226. CONCLUSION: Our results are consistent with those of studies in older infants in documenting an extremely low rate of serious bacterial infection other than UTI in infants less than 28 days admitted with clinical bronchiolitis, even though these febrile neonates have traditionally been thought to be at highest risk. This suggests that invasive CSF sampling and empiric antibiotic administration in this population may be safely avoided, though this would have to be confirmed in large-scale prospective studies. In our sample there was a significant risk of contamination and false positive bacterial cultures.
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How this classification was reachedexpand
Full frame machine prediction
Teacher imitationNot calibrated prevalence, not ground truth. Human validation pending. The Gemma side is a direct model label for every work in the frame, read from the title-only record. The Codex side is a classifier learned from the 10,348 direct Codex labels and calibrated to design-weighted sample rates; fields without enough sample support carry no Codex call. Candidate is the union of the two sides; consensus is their intersection. These outputs are machine_predicted_unvalidated and are not human labels.
Distilled classifier scores by category (both heads)
| Category | Codex | Gemma |
|---|---|---|
| Metaresearch | 0.001 | 0.005 |
| Meta-epidemiology (narrow) | 0.000 | 0.000 |
| Meta-epidemiology (broad) | 0.000 | 0.000 |
| Bibliometrics | 0.002 | 0.001 |
| Science and technology studies | 0.000 | 0.000 |
| Scholarly communication | 0.001 | 0.000 |
| Open science | 0.000 | 0.001 |
| Research integrity | 0.000 | 0.000 |
| Insufficient payload (model declined to judge) | 0.001 | 0.000 |
Machine scores (provisional)
The two teacher heads of the student model, read on this work. A score orders the frame for review; it never asserts a category, and the validation status ships verbatim with every row.
Baseline scores from an immature model (maturity gate not passed, 7 training rounds). Scores rank; they never assert a category.
score_only:v0-immature-baseline · verbatim from the scoring run: score_only means the number may rank works, and no category label ships from itClassification
machine, unvalidatedMachine predicted; a candidate call from one source (direct Gemma or distilled Codex), not a consensus.
How this classification was reached, model by model and score by score, is at the end of the page under "How this classification was reached".