Bacteremic Infants Research Articles

Occult bacteremia in toxic-appearing, febrile infants. A prospective clinical study in an office setting.

The prevalence of occult bacteremia was evaluated prospectively in two groups of infants: those with a toxic appearance and temperature greater than 38.8 C and a comparison group with similar fever but without a toxic appearance. All patients were diagnosed by one physician employed in a suburban, middle-class, private ambulatory pediatric practice. Toxicity scores were assigned based on the results of history and physical examination. Peripheral white blood cell (WBC) counts and blood cultures were obtained for every child. Of 52 toxic infants involved in the study, an infectious source, commonly otitis media, was found in 26 (50%). Eighteen patients (35%) had WBC counts above 15,000. Bacteremia was documented in six patients (12%), due to Streptococcus pneumoniae in five and to group C Streptococcus in one. Five bacteremic infants had toxic, febrile illnesses for which no overt focus could be identified. None of 31 febrile infants without a toxic appearance had bacteremia. We conclude that highly febrile, toxic-appearing infants are at risk for occult bacteremia even when they are seen in the pediatrician's office. Toxicity diagnosed on the basis of clinical findings in a febrile infant warrants obtaining a white blood cell count and a blood culture.

NITRO-BLUE TETRAZOLIUM (NBT) TEST IN BACTEREMIC NEONATES

The NBT test is used as supporting evidence for the diagnosis of sepsis in children and adults. In neonates the previously observed high values in normal subjects preclude such use. Our preliminary observations on 15 healthy term newborns showed that high heparin doses gave falsely elevated NBT values; when heparin dosage was controlled (1 unit/ml NBT solution) consistent values of <20% were obtained in 68 normal infants of 25-43 wks of gestation. Since respiratory distress is a common presenting sign for both hyaline membrane disease (HMD) and neonatal sepsis, we have performed the NBT test in 25 infants with such signs to evaluate the NBT test in the differential diagnosis of HMD vs. sepsis. Endotoxin-stimulated NBT preparations were also performed to insure phagocytic inducibility of the neutrophils. NBT slides were read without knowledge of each infant's clinical diagnosis. HMD was confirmed by classical chest roengenograms and a negative rapid surfactant test in gastric aspirate, and sepsis by positive blood (4 cases) or CSF (1 case) cultures. The results were as follows: Three additional bacteremic infants had no neutrophils on the NBT smears. The NBT test appears to be a reliable indicator of neonatal sepsis and may prove beneficial in the early differentiation of HMD from bacterial infection.