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Do Preemies Have Higher Rate of Serious Bacterial Infection?

April 4, 2024

Written by Rebecca White

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There was no difference in rates of bacteremia or meningitis between term and preterm infants with fever. Preterm infants had lower rates of urinary tract infection (UTI) compared to term infants.

Hot Take: febrile preemies may not have more infections
Data is limited on the rate of infection in preterm infants since many studies exclude this population. The 2021 American Academy of Pediatrics (AAP) guidelines for the evaluation of febrile infants applies only to term infants. However, 8.5% of all births are moderate to late preterm (32-36 weeks). Does this population need to be evaluated and treated more aggressively?

This multicenter observational cohort study compared rates of infection in moderate to late preterm infants to term infants (37-42 weeks) age 8-60 days with a diagnosis of fever. Data was pulled from the Pediatric Health Information System to include 19,507 infants, of which 2,162 were preterm. Hospital transfers, initial newborn hospitalization, infants with unknown gestational age, complex chronic conditions, or birth ≤31 weeks were excluded.

There was no significant difference in rates of bacteremia: 1.5% vs. 1.2% (P=0.44) or meningitis 0.16% vs. 0.05% (P=0.36). Preterm infants had lower rate of UTI than term infants: 1.8% vs 3.0% (P=0.001). The reason for this is unclear, but authors hypothesize physiologic differences or higher antibiotic exposure in preterm infants.

How will this change my practice?
This study has considerable limitations, including a large cohort excluded for unknown gestational age, and further studies are needed on this topic. With these results, I will use the AAP recommendations to guide my workups, with modifications based on clinical presentation and my gestalt.

Rate of Urinary Tract Infections, Bacteremia, and Meningitis in Preterm and Term Infants. Pediatrics. 2024 Mar 13. doi: 10.1542/peds.2023-062755. Epub ahead of print.

What are your thoughts?