PECARN Pearls: Insights in Navigating Pneumonia Diagnosis in Febrile Infants

Febrile infants ages 60 days and younger present unique challenges for emergency providers, with serious bacterial infections (SBI) posing a significant risk. Among the various potential infections, pneumonia is a critical concern, with prevalence ranging from 0.1% to 8% in these young infants. Current diagnostic practices, primarily relying on clinical impression, struggle to identify pneumonia accurately.

A recent study published in the Emergency Medicine Journal, sheds light on the demographic, clinical, and biomarker factors associated with radiographic pneumonias in this vulnerable population. The study, led by Todd Florin, MD, MSCE, of Ann & Robert H. Lurie Children’s Hospital of Chicago, is a secondary analysis of data from the Pediatric Emergency Care Applied Research Network (PECARN).

“This research is a step forward in our understanding of pneumonia in febrile infants and refining clinical practices to optimize outcomes,” says Florin.

Key Findings

The study, conducted from June 2016 to April 2019 across 18 emergency departments, enrolled 568 febrile infants ages 60 days and younger. Of the febrile infants who had a CXR performed, definite pneumonias were present in 3.3% (n=19) and possible pneumonias were present in 6.0% (n=34). Notably, signs of respiratory distress, including grunting, nasal flaring, retractions, or tachypnea, were the only physical exam findings that were significantly associated with radiographic pneumonias. A higher proportion of infants with possible or definite pneumonias had influenza or RSV detected (52.9% and 36.8%, respectively) in their nasopharynx compared with those without (21%) pneumonias. There were elevations in certain laboratory markers in infants with pneumonias. In this study, the median WBC count was slightly higher in infants with possible or definite pneumonias compared with no pneumonias. The ANC and PCT concentrations were significantly higher in infants with definite pneumonias. No infant with radiographic pneumonia had bacteremia.

Implications for Practice

Radiographic pneumonia is uncommon in young febrile infants. A CXR in every febrile infant without signs or symptoms of a respiratory infection is unnecessary. Consider a CXR in the febrile infant with increased work of breathing/respiratory distress. Elevated biomarkers (ANC/procalcitonin) can support the diagnosis of pneumonia as well.

Read the full paper or learn more about PECARN.