“Fever in young babies, unless they have a runny nose or something similar, can be a symptom of a serious bacterial infection. One in four or five has a urinary tract infection and one in 25 or 30 has a blood infection or meningitis. Thus, emergency services and pediatricians prescribe tests to confirm the diagnosis and prescribe antibiotics if necessary, “explains Dr. Roberto Velasco, a pediatrician with long experience in children’s emergencies in Río Hortega.
However, “on other occasions, in one out of every 24 or 30, what the child suffers from is a virus and, of course, if you manage to detect it, as with the flu, for example, you can safely rule out other causes of their symptoms and avoid punctures and antibiotics that are totally unnecessary for the child”, he adds.
But this routine and usual knowledge of clinical practice had all the doubts about what was happening with the coronavirus. Does SARS-CoV-2 behave the same? Will a baby who tests positive and has a fever need blood work, urine tests, or a spinal tap? Do you allow a flu-like protocol or require a new one?
To answer these questions, after the serious waves and when a certain lull from the pandemic allowed it, a team of pediatricians from Río Hortega reviewed these cases to establish clear medical criteria on how to act when a child has covid and hyperthermia. And this is the work of Elena Granda, assistant in Pediatrics at the Emergency Room and Neonates, and Silvia Pérez Parra, a second-year resident who will make this research her doctoral thesis under the methodological direction of Helvia, also a specialist in children in Primary Care in Segovia Benito and Dr. Roberto Velasco, responsible for the design and analysis of the work and a pediatrician at the RíoHortega Emergency Room when the work was carried out.
Silvia Pérez explains that “when a child under three months old has a fever, they are susceptible to a serious infection. Your immune system is very immature and a high temperature without detecting a clear source, without mucus, forces the doctor to rule out a serious bacterial infection. With the flu we knew what happens in epidemic periods, a low ratio; but in cases of coronavirus you are obliged to carry out tests on the child that may be avoidable.
«With covid, being something new, we still didn’t know what was going on, and that’s why we proposed the study. But because everything is so recent, it wasn’t possible to collect enough patients to draw clear conclusions with certainty. Therefore, we thought of a meta-analysis, which it does is collect data from many studies, and through a reasonably complex statistical analysis, it manages to analyze everything as if it were the same study”, emphasize those responsible for this work. which will be presented at the end of April at the Congress of the American Society of Pediatrics in Washington and in May at the Congress of the Spanish Society of Pediatric Emergencies.
2,612 children with fever and confirmed covid and less than 90 days old were part of the Río Hortega case review study
Work began last August and “we went back to the beginning of the pandemic, from February 2020 to December 2022. We were incorporating what was coming out”, explain those responsible. Librarian María Luz de Andrés – although everyone calls her Cuca – collaborated with the team in the search for all published studies on the subject in all parts of the world. This allowed a large volume of small patients, which would be impossible if it were done only with those in a hospital.
Elena Granda and Silvia Pérez explain that, in this way, they were able to review a thousand works. A first selection was made with the title, abstract and conclusions and once those who responded to such content were selected, 31 from 19 different countries, this team of pediatricians carried out a statistical analysis and a more in-depth study of each work where the child was diagnosed with antigen test or PCR test. Thus, 2,612 cases of children could be analyzed.
“After analysis, we can say with quite confidence that the probability of a bacterial blood infection or meningitis in a small child with a fever and positive for covid is one in a thousand, and he cannot be stung, as long as he looks good. But urinary infection, on the other hand, has to be ruled out anyway and an analysis needs to be done ». “This avoids -adds Helvia Benito- having to do a lumbar puncture for fear of meningitis or draw blood from these very small children”.
Doctors Borja Gómez, from Hospital Cruces ed Bilbao, and Damian Roland, from Leicester (England), also collaborated with the work.
It should be borne in mind that approximately 10% to 20% of febrile infants under three months of age who attend the ER have a bacterial infection, including invasive bacteria such as meningitis, bacteremia, or urinary tract infection. Among these patients, bacterial infection has a prevalence of between 2% and 3%; although this rate is even higher in the first weeks of life. Management of these infants usually consists of extensive evaluations, hospitalization, and antimicrobial treatment. However, the management of these little ones has changed considerably in the last two decades and it is increasingly possible to identify patients with a very low risk of urinary tract infections, bacteremia or meningitis, that is, who do not require treatment with antibiotics, which allows outpatient management. . The child can be at home.