Respiratory viral infection status is not an accurate clinical determinant in distinguishing SBI risk in febrile neonates

Objectives: To analyze a large group of febrile neonates < 28 days of age who received outpatient sepsis evaluation and nasopharyngeal aspirate antigen testing [NPAT] for respiratory syncytial viral [RSV] infection to determine whether there is a clinically-significant association between viral study results and risk for serious bacterial infection [SBI: bacterial meningitis, bacteremia, urinary tract infection, bacterial enteritis]. Methods: We evaluated consecutive febrile neonates < 28 days of age presenting to our urban pediatric emergency department [MMC] during a 6-year period, all of whom received a sepsis evaluation [CSF, blood, urine cultures] and RSV NPAT testing. To achieve adequate power [80%], the MMC data was combined with similar data reported from a prior prospective PEM-CRC study1 of like-aged febrile neonates who received similar evaluation. Results: From the MMC data of consecutively evaluated cases, the prevalence rate of +RSV in 387 febrile neonates was 6%. Of these, 378 [98%] received both a sepsis evaluation and RSV NPAT; +SBI occurred in 4/22 [18.1%] with +RSV vs 58/356 [16.2%] with -RSV [p = 0.77]. Combined with the PEM-CRC1 cohort of 411 febrile neonates < 28 days of age who received similar evaluation, a total of 789 cases were analyzed using meta-analysis. Overall, there were 117 cases of +SBI [14.8%]; and 104 cases of +RSV [13.2%]. The rate of +SBI was 11.5% in those with +RSV vs 15.3% in those with –RSV. Meta-analysis performed showed no significant difference in rates of +SBI between those with and without +RSV [OR = 0.78, 95% CI 0.41 – 1.50; p = 0.46]. Conclusion: Rates of +SBI are not significantly different between febrile neonates < 28 days of age with and without +RSV. Respiratory viral infection status is not an accurate clinical determinant in distinguishing SBI risk in febrile neonates.