Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
Meta-Analysis
. 2019 Mar 1;2(3):e190874.
doi: 10.1001/jamanetworkopen.2019.0874.

Prevalence of Bacteremia and Bacterial Meningitis in Febrile Neonates and Infants in the Second Month of Life: A Systematic Review and Meta-analysis

Eric A Biondi  1   2 , Brian Lee  3 , Shawn L Ralston  4 , Jared M Winikor  2 , Justin F Lynn  2 , Angela Dixon  5 , Russell McCulloh  3   6
Affiliations
Meta-Analysis

Prevalence of Bacteremia and Bacterial Meningitis in Febrile Neonates and Infants in the Second Month of Life: A Systematic Review and Meta-analysis

Eric A Biondi et al. JAMA Netw Open. .

Abstract

Importance: Febrile neonates (persons in the first month of life) are believed to be at higher risk for bacteremia or bacterial meningitis than infants in their second month of life. However, the true prevalence is unclear.

Objective: To determine modern rates of bacteremia and bacterial meningitis in febrile neonates and infants in the second month of life presenting to an ambulatory setting.

Data sources: A comprehensive, no-limit search was conducted in PubMed using previously published search terms in February 2015 and repeated in September 2016.

Study selection: Abstracts and full texts were reviewed independently by several investigators. Studies were included if data regarding blood cultures or cerebrospinal fluid cultures from consecutive febrile infants in an ambulatory setting could be extrapolated within the age groups. To limit the analysis to the period after the availability of the Haemophilus influenzae type b vaccination, studies that collected data before 1990 were excluded.

Data extraction and synthesis: Data were extracted in accordance with the Meta-analyses of Observational Studies in Epidemiology (MOOSE) reporting guidelines via independent abstraction by several investigators. The Newcastle-Ottawa Scale was used to assess bias.

Main outcomes and measures: The primary outcomes were prevalence rates of bacteremia and bacterial meningitis in febrile neonates and infants in the second month of life. In neonates, prevalence rates were also estimated in the era of group B Streptococcus intrapartum antibiotic prophylaxis (after 1996).

Results: In total, 7264 abstracts were screened, resulting in 188 full-text manuscripts reviewed, with 12 meeting inclusion criteria (with 15 713 culture results). For febrile neonates, the prevalence of bacteremia was 2.9% (95% CI, 2.3%-3.7%; I2 = 50%; n = 5145) and the prevalence of bacterial meningitis was 1.2% (95% CI, 0.8%-1.9%; I2 = 27%; n = 3288). In neonates in the era after group B Streptococcus prophylaxis, the prevalence of bacteremia was 3.0% (95% CI, 2.3%-3.9%; I2 = 6%; n = 2055) and the prevalence of meningitis was 1.0% (95% CI, 0.4%-2.1%; I2 = 28%; n = 1739). For febrile infants in the second month of life, the prevalence of bacteremia was 1.6% (95% CI, 0.9%-2.7%; I2 = 78%; n = 4778) and the prevalence of meningitis was 0.4% (95% CI, 0.2%-1.0%; I2 = 33%; n = 2502).

Conclusions and relevance: These findings suggest that febrile neonates have approximately twice the rate of bacteremia and meningitis as febrile infants in their second month of life.

PubMed Disclaimer

Conflict of interest statement

Conflict of Interest Disclosures: Dr Biondi reported receiving personal fees as a consultant for McKesson Inc. Dr Lee reported receiving grants from Pfizer, Merck & Co, and the Patient-Centered Outcomes Research Institute outside the submitted work. Dr McCulloh reported receiving funding from the office of the Director of the National Institutes of Health for Pediatric Clinical Trials Research Conduct, grant number UG1OD024953. No other disclosures were reported.

Figures

Figure 1.
Figure 1.. Flowchart of Eligible Studies
Figure 2.
Figure 2.. Meta-analysis of Prevalence of Bacteremia and Meningitis in Febrile Neonates and Infants in the First and Second Months of Life
For each subgroup, the sum of the statistics, along with the summary prevalence, is represented by the middle of the solid diamonds. The width of the diamonds represents summary 95% CIs; squares represent mean values, with error bars representing 95% CIs.
Figure 3.
Figure 3.. Meta-analysis of Prevalence of Bacteremia and Meningitis in Febrile Neonates in the First Month of Life
For each subgroup, the sum of the statistics, along with the summary prevalence, is represented by the middle of the solid diamonds. The width of the diamonds represents summary 95% CIs; squares represent mean values, with error bars representing 95% CIs.
Figure 4.
Figure 4.. Meta-analysis of Prevalence of Bacteremia and Meningitis in Febrile Infants in the Second Month of Life
For each subgroup, the sum of the statistics, along with the summary prevalence, is represented by the middle of the solid diamonds. The width of the diamonds represents summary 95% CIs; squares represent mean values, with error bars representing 95% CIs.
See this image and copyright information in PMC

References

    1. Hui C, Neto G, Tsertsvadze A, et al. . Diagnosis and management of febrile infants (0-3 months). Evid Rep Technol Assess (Full Rep). 2012;(205):-. - PMC - PubMed
    1. Pantell RH, Newman TB, Bernzweig J, et al. . Management and outcomes of care of fever in early infancy. JAMA. 2004;291(10):1203-1212. doi:10.1001/jama.291.10.1203 - DOI - PubMed
    1. Bachur RG, Harper MB. Predictive model for serious bacterial infections among infants younger than 3 months of age. Pediatrics. 2001;108(2):311-316. doi:10.1542/peds.108.2.311 - DOI - PubMed
    1. Byington CL, Reynolds CC, Korgenski K, et al. . Costs and infant outcomes after implementation of a care process model for febrile infants. Pediatrics. 2012;130(1):e16-e24. doi:10.1542/peds.2012-0127 - DOI - PMC - PubMed
    1. Huppler AR, Eickhoff JC, Wald ER. Performance of low-risk criteria in the evaluation of young infants with fever: review of the literature. Pediatrics. 2010;125(2):228-233. doi:10.1542/peds.2009-1070 - DOI - PubMed

Publication types