To determine the prevalence of serious bacterial infection
younger than 3 months with fever ≥40°C.
We retrospectively identified all infants
younger than 3 months with fever who presented to a pediatric emergency department. The medical records were reviewed. The prevalence of serious bacterial infection
(SBI) among those patients with hyperpyrexia
was compared with febrile infants
with lower fever.
younger than 3 months with fever were reviewed. Ninety-eight patients (1.7%) had triage temperature ≥40°C rectally. Median age, temperature, and white blood count for those with hyperpyrexia
were 58 days (interquartile range [IQR] 36-78 days), 40.2°C (IQR, 40.0-40.4°C), and 10,800/mm3
), respectively. Diagnostic studies included blood culture (100%), urine culture (100%), lumbar puncture (100%), chest radiographs (34%), and stool cultures (11%). SBI was found in 38% infants
: urinary tract infection was the most common SBI (71%). Among patients with hyperpyrexia
, patients with SBI had similar mean white blood cell counts (14,000 vs. 10,200 cells/mm3
) and age (54 vs. 53 days) as those with hyperpyrexia
but no SBI. The prevalence of SBI among febrile infants
with temperatures ≥40.0°C was 38% (95% CI 27-48%) compared with those with fever ≤40°C: 8.8% (95% CI 8.1-9.5%).
is rare among febrile infants
younger than 3 months. One-third of infants
with temperature ≥40.0°C had SBI. Future management algorithms might include hyperpyrexia
as a risk factor for serious infection.