Abstract
BACKGROUND: To date, no consensus has been reached regarding the evaluation and
management of young febrile children, and no single laboratory test has been shown to
reliably identify young children at high or low risk of having serious bacterial illness.
Knowing the local prevalence of SBI is essential in formulating management strategies
because extrapolation from studies done elsewhere is difficult.
AIMS: i) To determine the prevalence of SBI in young febrile children served by a
paediatric hospital. Ii) To evaluate the role of cytokines in predicting SBI in these
children.
HYPOTHESIS: IL-6, IL-8 and sICAM-1 can accurately predict SBI in young febrile
children.
METHODOLOGY: The study population was children seen at the emergency department of
the Edinburgh Royal Hospital for Sick Children. All children ≤5 years old with a
temperature of ≥38.5°C were studied over a 12-month period. Demographic, clinical and
laboratory data were collected prospectively. Serum IL-6, IL-8 and sICAM-1 were
measured by ELISA. The performance characteristics of the cytokines in predicting SBI
were compared to those of the traditional tests (WBC, ANC, CRP, ESR).
RESULTS: 618 patients fulfilled the study criteria of age and temperature. 26.7% of the
patients had a SBI. The commonest SBI was pneumonia. 2.7% of blood cultures were
positive, over half were streptococcus pneumoniae. 40% of positive blood cultures were
from patients discharged with an apparently benign illness. The modest gain in the posttest probability of SBI was comparable between the cytokines and the traditional tests.
Serum IL-6 and IL-8 was elevated in all patients with bacteraemia or meningitis. A
model based on the respiratory rate, CRP, and sICAM-1 correctly identified 70% of SBI.
CONCLUSION: The prevalence of SBI, and bacteraemia, in young febrile children is still
high in spite of the decline in immunizable diseases. Highly febrile young children
should continue to be evaluated with a blood culture and close follow up, and UTI
should be excluded in all infants. IL-6 and IL-8 appear to be sensitive markers for
bacteraemia and meningitis and their role requires further evaluation.
