Risk factors associated with serious bacterial infections among newborns with high body temperature

Abstract

Introduction: Recognizing the importance of serious bacterial infections (SBIs), study aimed to identify factors associated with high body temperature in newborns.

Methods: A convenience sample of 54 newborns admitted to our hospital in Iran (March-July 2015) with rectal temperature > 38°C (100.4°F) were examined for clinical signs, blood cultures, complete blood counts, platelets, Erythrocyte Sedimentation Rate (ESR), C-reactive protein (CRP), renal function, chest/abdominal x-rays, spinal tap, and history of maternal infections.

Results: Newborns had either fever due to infections, or hyperthermia due to dehydration and/or extreme warm environment. Bacterial infections (37%) included: sepsis (15%) (coagulase-positive or coagulase-negative Staphylococci, Enterobacter, Klebsiella, Escherichia coli), meningitis (13%), and 3.5% UTI, 3.5% pneumonia, 2% cellulitis, and 2% omphalitis. Degrees of dehydration experienced by 55.6% included 37% of cases associated with hyperthermia caused by warm clothing/environment, while in 18.6% dehydration was secondary to fever. Viral infections (11%) included upper respiratory infections, gastroenteritis, while in remaining 13% cause of high body temperature was unknown. The group with SBIs had higher chance of having history of PROM (premature rupture of membrane) (p = 0.023), positive CRP (p = 0.041), and abnormal platelets count (p = 0.021) comparing all others.

Conclusions: High body temperature in newborns needs careful evaluation to identify fever due to SBIs. In sepsis cases, antibiotics should cover prevalent bacteria including Staphylococci and Enterobacter. Dehydration was prevalent among newborns with high body temperature due to hyperthermia or secondary to infections. To avoid hyperthermia, parents should know how to clothe their newborns appropriate for environmental temperature. Newborns' SBIs associated with positive CRP, abnormal platelet count, and maternal PROM.

Keywords: Dehydration; Fever; High body temperature; Hyperthermia; Newborns; Serious bacterial infection.