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Study: Most Infants With Fevers Don’t Need Spinal Taps

Infants with fevers can end up in the ER with spinal taps. But new research suggests that physicians often overreact, and that there's a better way.

When adults get fevers, we feel awful for a while and move on with our lives. Baby fever is more serious. When infants catch fevers, they often end up in the ER with spinal taps. But now, new research in JAMA Pediatrics suggests that physicians overreact to minor fevers, pushing invasive procedures on newborns who don’t need them. There’s the better way, the authors maintain, are three minimally invasive tests that can rule out serious infection

“Missing a serious bacterial infection in an infant can lead to severe complications, which is why physicians traditionally have been very cautious and included invasive procedures, medications, and hospitalizations when evaluating these infants,” said coauthor on the study Nathan Kuppermann, chair of emergency medicine at UC Davis School of Medicine, in a statement. Kuppermann and colleagues identified predictors of serious infection so that physicians can start sending minor cases home and aggressively treat only the most serious infections.

“It’s essentially a mathematical tool for physicians to confidently make clinical decisions about young infants with fevers to identify those who are at low risk of serious bacterial infections,” Kuppermann explained 

At least 90 percent of infants who get fevers do not have serious bacterial infections. But for the 10 percent or so who do, a fever can be the first sign of a life-threatening condition. To be on the safe side, it has long been standard procedure in the United States for an infant running a fever to be hospitalized, placed on antibiotics, or subjected to invasive and uncomfortable testing, such as spinal taps, until bacterial infection can be ruled out. It’s a nightmare, but a necessary nightmare. Or it was necessary, until Kupperman released these new guidelines.

After observing nearly 2,000 infants with fevers, the authors demonstrated that bacterial infection could be ruled out with three minimally invasive tests—a urinalysis and two blood tests.

Still, the tests are not perfect. Kuppermann and colleagues recommend further studies and encourage physicians to continue to follow their guts—especially when treating newborns. “Clinicians must remain particularly wary in cases where infants are younger than 28 days,” said coauthor Octavio Ramilo of Nationwide Children’s Hospital. “That is the age group in whom the risks of bacteremia and bacterial meningitis, as well as herpes encephalitis, are the greatest.”