Febrile infants in the emergency department of a public hospital in India: respiratory infections lead the pack

Abstract

Background: The objective of study was to find the etiology, signs and symptoms of fever of 4-7 days in the age group of 91 days 2 years and their outcome following treatment in a tertiary care hospital.Methods: This was a prospective study conducted at the Emergency Department (ED) of a public hospital in New Delhi between April, 2018 and January, 2019. 150 children aged 3 months to 2 years with 4-7 days of fever were included. Demographic, clinical and diagnostic data were collected, and children were managed using ACEE-INDIA guidelines, telephonic follow-up was done for those discharged from ED.Results: Out of 150 children, respiratory tract infections were most common etiological group (64%), followed by gastrointestinal infections (16.7%) and CNS infections (9.3%). Fever with cough (with respiratory distress-27.3%) was the most common symptom in these children. Overall, 61% were admitted; majority (58%) being with respiratory problems. Median (IQR) duration of stay in admitted children was 2 (0, 3) days. Mortality was observed in 12 (8%) children. Mortality was 4 times higher in children with CNS infections as compared to other conditions [RR=4.14 (1.4 to 12.4); P=0.01].Conclusions: Fever in the ED among Indian infants at a public hospital was mainly due to respiratory infection, which could be managed on outpatient-basis in the majority using the ACEE-INDIA (Academic College of Emergency Experts in India) guidelines. However, among those admitted, neurological conditions were the most common cause of death.