Sacred Heart Journal

Abstract Objective To describe trends and variation in testing, treatment, and disposition of febrile infants aged 61-90 days evaluated in US emergency departments (EDs). Study design For this retrospective cohort study, we included noncritically ill, previously healthy infants aged 61-90 days with temperatures ≥ 38°C evaluated at 12 Pediatric Emergency Care Applied Research Network Registry EDs during 2014-2015 (trends analysis) and 17 EDs in 2014-2015 (variation analysis). Outcomes included urine, blood, cerebrospinal fluid, and respiratory viral testing; antibiotic administration; hospitalization; and invasive bacterial infections. Results We included 9041 infants in the trends analysis and 4448 in the variation analysis. From 2017-2023, urine testing (53.8% to 45.7%; P < .01), blood cultures (35.0% to 18.9%; P < .01), cerebrospinal fluid testing (3.8% to 1.1%; P < .01), hospitalizations (22.6% to 16.9%; P < .01), and parenteral antibiotics (10.2% to 5.8%; P < .01) decreased. Conversely, respiratory viral testing (13.4% to 63.3%; P < .01) and procalcitonin use increased (1.6% to 14.2%; P < .01). In 2022-2023, a median 46.3% of infants had urine testing (range: 32.2%-73.9% across hospitals), 21.1% had blood cultures (range: 8.0%-51.1%), and 16.2% were hospitalized (range: 7.9%-26.1%). Respiratory viral testing (median 71.8%; range: 34.7%-95.5%) and procalcitonin use (median 13.4%; range: 0%-37.0%) also varied. The prevalence of invasive bacterial infections was similarly low across hospitals (median 0.3%; range: 0%-1.2%). Conclusions There has been significant change over time in testing and disposition of febrile infants aged 61-90 days, although with substantial interhospital variation. Implementation of decision support tools is needed to standardize management and reduce practice variations.

Abstract Objectives: The aim of this study was to compare maternal knowledge and perceptions of fever, fever management practices, and information sources of mothers of children with and without a history of febrile seizures. Methods: A questionnaire was used to survey mothers of children who visited health departments for a routine 18-month-old well baby check-up. Results: A total of 386 responses were analyzed. More mothers of children with a history of febrile seizures than mothers of children without it stated that high fever caused febrile seizures and antipyretics prevented it. Fewer mothers of children with a history of febrile seizures than mothers in the other group thought that high fever caused brain damage and antipyretics prevented the disease from worsening and warmed the child's body during fever episode. Many mothers in both groups stated that they considered physicians to be their primary information source. Spouse and own parents were named as information sources among mothers of children with a history of febrile seizures, whereas books and the Internet were named in the other group. Conclusions: Mothers of children with a history of febrile seizures demonstrated a higher rate of accuracy in their knowledge of fever than those in the other group. Mothers of children with a history of febrile seizures used personal communication, whereas those in the other group relied on mass communication for health information. Providing accurate information to family members is essential to provide mothers with both accurate information and emotional support.

Abstract Ambulatory blood pressure monitoring (ABPM) provides superior information for diagnosis and treatment of pediatric hypertension, but for reasons of practicality, clinic blood pressure measurements (CBP) are still the primary diagnostic tool. Regular home blood pressure measurements (HBP) may be an alternative to ABPM, but this technique awaits validation in practice. We analyzed the concordance of ABPM, CBP and HBP in 118 pediatric patients (3-19 y) with chronic renal failure. HBP readings (10.5 ± 5.4 per patient) were averaged for one week around the day of ABPM and CBP. Mean arterial pressure (MAP) measured by HBP (84.0 ± 10 mm Hg) was significantly lower than both CBP (86.1 ± 14.1 mm Hg, P < 0.05) and daytime ABPM (90.3 ± 10.4 mm Hg, P < 0.05). HBP detected hypertensive patients with greater specificity (82 versus 70%), but lower sensitivity (52 versus 70%) than CBP. The fraction of patients rated erroneously hypertensive was 23% with CBP, but only 14% with HBP. The 95% limits of agreement with ABPM were narrower for HBP (-23 to10 mm Hg) than for CBP (-30 to 21 mm Hg). CBP, but not HBP measurements, were less precise in the upper BP range. The accuracy of HBP measurements did not change with use over a six months time period. In conclusion, HBP was superior to CBP in predicting ABPM, but neither CBP nor HBP detected hypertension with enough sensitivity or specificity to replace ABPM. The greater specificity of HBP compared with CBP makes it a more suitable tool for diagnosis, rather than screening, of hypertension in children.