{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,11,10]],"date-time":"2026-11-10T12:24:46Z","timestamp":1794313486141,"version":"4.9.0"},"reference-count":24,"publisher":"American Academy of Pediatrics (AAP)","issue":"1","content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":[],"published-print":{"date-parts":[[2021,1,1]]},"abstract":"\n OBJECTIVES:<\/jats:title>\n To describe the characteristics and outcomes of afebrile infants \u226460 days old with invasive bacterial infection (IBI).<\/jats:p>\n <\/jats:sec>\n \n METHODS:<\/jats:title>\n We conducted a secondary analysis of a cross-sectional study of infants \u226460 days old with IBI presenting to the emergency departments (EDs) of 11 children\u2019s hospitals from 2011 to 2016. We classified infants as afebrile if there was absence of a temperature \u226538\u00b0C at home, at the referring clinic, or in the ED. Bacteremia and bacterial meningitis were defined as pathogenic bacterial growth from a blood and\/or cerebrospinal fluid culture.<\/jats:p>\n <\/jats:sec>\n \n RESULTS:<\/jats:title>\n Of 440 infants with IBI, 78 (18%) were afebrile. Among afebrile infants, 62 (79%) had bacteremia without meningitis and 16 (20%) had bacterial meningitis (10 with concomitant bacteremia). Five infants (6%) died, all with bacteremia. The most common pathogens were Streptococcus agalactiae (35%), Escherichia coli (16%), and Staphylococcus aureus (16%). Sixty infants (77%) had an abnormal triage vital sign (temperature &lt;36\u00b0C, heart rate \u2265181 beats per minute, or respiratory rate \u226566 breaths per minute) or a physical examination abnormality (ill appearance, full or depressed fontanelle, increased work of breathing, or signs of focal infection). Forty-three infants (55%) had \u22651 of the following laboratory abnormalities: white blood cell count &lt;5000 or &gt;15\u2009000 cells per \u03bcL, absolute band count &gt;1500 cells per \u03bcl, or positive urinalysis. Presence of an abnormal vital sign, examination finding, or laboratory test result had a sensitivity of 91% (95% confidence interval 82%\u201396%) for IBI.<\/jats:p>\n <\/jats:sec>\n \n CONCLUSIONS:<\/jats:title>\n Most afebrile young infants with an IBI had vital sign, examination, or laboratory abnormalities. Future studies should evaluate the predictive ability of these criteria in afebrile infants undergoing evaluation for IBI.<\/jats:p>\n <\/jats:sec>","DOI":"10.1542\/hpeds.2020-002204","type":"journal-article","created":{"date-parts":[[2021,1,1]],"date-time":"2021-01-01T10:20:13Z","timestamp":1609496413000},"page":"100-105","source":"Crossref","is-referenced-by-count":14,"title":["Characteristics of Afebrile Infants \u226460 Days of Age With Invasive Bacterial Infections"],"prefix":"10.1542","volume":"11","author":[{"given":"Marie E.","family":"Wang","sequence":"first","affiliation":[{"name":"Division of Pediatric Hospital Medicine, Department of Pediatrics, Lucile Packard Children\u2019s Hospital Stanford and School of Medicine, Stanford University, Palo Alto, California;"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Mark I.","family":"Neuman","sequence":"additional","affiliation":[{"name":"Division of Emergency Medicine, Boston Children\u2019s Hospital and Harvard Medical School, Harvard University, Boston, Massachusetts;"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Lise E.","family":"Nigrovic","sequence":"additional","affiliation":[{"name":"Division of Emergency Medicine, Boston Children\u2019s Hospital and Harvard Medical School, Harvard University, Boston, Massachusetts;"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Christopher M.","family":"Pruitt","sequence":"additional","affiliation":[{"name":"Division of Pediatric Emergency Medicine, Department of Pediatrics, University of Alabama at Birmingham, Birmingham, Alabama;"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Sanyukta","family":"Desai","sequence":"additional","affiliation":[{"name":"Division of Hospital Medicine, Department of Pediatrics, Cincinnati Children\u2019s Hospital Medical Center and College of Medicine, University of Cincinnati, Cincinnati, Ohio;"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Adrienne G.","family":"DePorre","sequence":"additional","affiliation":[{"name":"Division of Hospital Medicine, Department of Pediatrics, Children\u2019s Mercy Hospital, Kansas City, Missouri;"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Laura F.","family":"Sartori","sequence":"additional","affiliation":[{"name":"Division of Pediatric Emergency Medicine, Department of Pediatrics, Monroe Carell Jr Children\u2019s Hospital at Vanderbilt and School of Medicine, Vanderbilt University, Nashville, Tennessee;"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Richard D.","family":"Marble","sequence":"additional","affiliation":[{"name":"Division of Emergency Medicine, Ann and Robert H. 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