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Relying on clinical guidelines to treat young infants with fevers may not improve outcomes

Experienced pediatricians who relied on their clinical judgment more than existing clinical guidelines were able to minimize hospitalizations and avoid unnecessary lab testing for infants with fevers without a negative impact on the outcomes of care, according to a recent study supported in part by the Agency for Healthcare Research and Quality (HS06485).

Underlying conditions associated with fever symptoms in infants are difficult to recognize and range from minor illnesses to those that are life threatening. Expensive strategies that include hospitalization, extensive laboratory testing, and intravenous antibiotics traditionally have been used for diagnosis and treatment of infants with fever to protect against bacterial meningitis and bacterial blood infections. Illnesses such as these affect approximately 2 percent to 3 percent of infants with fevers.

Researchers led by Robert H. Pantell, M.D., of the University of California, San Francisco, worked with more than 573 clinicians' offices in 44 States that were part of the American Academy of Pediatrics' Pediatric Research in Office Settings Network from 1995 to 1998. The more than 3,000 infants in the study were aged 3 months or younger, had a fever of at least 100.4°F, and had no other major health problems (such as congenital anomalies, extreme prematurity, or conditions associated with organ system failure). At the time of the study, clinical practice guidelines for treating infants with fevers recommended that all infants under 1 month of age be hospitalized and treated with antibiotics and that laboratory tests be routinely performed on all infants younger than 3 months. This remains the current standard of care.

The researchers found that clinicians followed clinical practice guidelines to treat infants with fevers 42 percent of the time. Clinicians performed lab tests in 75 percent of the infants and treated 57 percent with antibiotics. In the first month of life, 40 percent fewer infants were hospitalized when clinicians did not follow guidelines. Rather than hospitalization, the clinicians saw many infants in repeated office visits and had frequent telephone followup. The infants who were treated in the office and with followup visits experienced similar results compared with those who would have been treated following the guidelines.

For more information, see "Management and outcomes of care of fever in early infancy," by Dr. Pantell, Thomas B. Newman, M.D., M.P.H., Jane Bernzweig, Ph.D., and others, in the March 10, 2004, Journal of the American Medical Association 291(10), pp. 1203-1212.

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