Marom et al identified febrile neonates at low risk for serious bacterial infection (SBI). This can help to decide if the patient should be started on antibiotics or observed. The authors are from HaEmek Medical Center in Afula, Israel.
Patient selection: febrile neonate with rectal temperature >= 38°C
Parameters:
(1) medical history
(2) general appearance
(3) focal physical signs of infection
(4) ESR in mm in first hour
(5) WBC count per µL
(6) urinalysis by dipstick
Parameter
Finding
Points
medical history
remarkable
0
unremarkable
1
general appearance
not good
0
good
1
focal signs of infection
present
0
absent
1
ESR
>= 30 mm/hr
0
< 30 mm/hr
1
WBC count
< 5,000 per µL
0
5,000 to 15,000 per µL
1
> 15,000 per µL
0
urine dipstick
abnormal
0
normal
1
total score =
= SUM(points for all 6 parameters)
Interpretation:
• mnimum score: 0
• maximum score: 6
• A score of 6 indicates a neonate at low risk for serious bacterial infection (SBI). A score less than 6 indicates a child at risk for SBI.
• A neonate identified as low risk for infection has a risk of serious bacterial infection less than 1% vs 49% in neonates not at low risk.
Performance:
• The negative predictive value for the score was 99%.
Limitations:
• The study was observational.
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