PEDIATRICS Vol. 122 No. 5 November 2008, pp. 947-954 (doi:10.1542/peds.2007-3206)
ARTICLE |
Office-Based Treatment and Outcomes for Febrile Infants With Clinically Diagnosed Bronchiolitis
a Department of Pediatrics, Harvard Medical School, Boston, Massachusetts
b Department of Pediatrics, University of Vermont, Burlington, Vermont
c Departments of Pediatrics
d Epidemiology and Biostatistics, University of California, San Francisco, California
e Pediatric Research in Office Settings, Department of Research, American Academy of Pediatrics, Elk Grove Village, Illinois
OBJECTIVES. The goals were to describe the (1) frequency of sepsis evaluation and empiric antibiotic treatment, (2) clinical predictors of management, and (3) serious bacterial illness frequency for febrile infants with clinically diagnosed bronchiolitis seen in office settings.
METHODS. The Pediatric Research in Office Settings network conducted a prospective cohort study of 3066 febrile infants (<3 months of age with temperatures 
38°C) in 219 practices in 44 states. We compared the frequency of sepsis evaluation, parenteral antibiotic treatment, and serious bacterial illness in infants with and without clinically diagnosed bronchiolitis. We identified predictors of sepsis evaluation and parenteral antibiotic treatment in infants with bronchiolitis by using logistic regression models.
RESULTS. Practitioners were less likely to perform a complete sepsis evaluation, urine testing, and cerebrospinal fluid culture and to administer parenteral antibiotic treatment for infants with bronchiolitis, compared with those without bronchiolitis. Significant predictors of sepsis evaluation in infants with bronchiolitis included younger age, higher maximal temperature, and respiratory syncytial virus testing. Predictors of parenteral antibiotic use included initial ill appearance, age of <30 days, higher maximal temperature, and general signs of infant distress. Among infants with bronchiolitis (N = 218), none had serious bacterial illness and those with respiratory distress signs were less likely to receive parenteral antibiotic treatment. Diagnoses among 2848 febrile infants without bronchiolitis included bacterial meningitis (n = 14), bacteremia (n = 49), and urinary tract infection (n = 167).
CONCLUSIONS. In office settings, serious bacterial illness in young febrile infants with clinically diagnosed bronchiolitis is uncommon. Limited testing for bacterial infections seems to be an appropriate management strategy.
Key Words: bronchiolitis • febrile infants • practice guidelines • practice variability
Abbreviations: PROS—Pediatric Research in Office Settings • AAP—American Academy of Pediatrics • SBI—serious bacterial illness • RSV—respiratory syncytial virus • UTI—urinary tract infection • CI—confidence interval
Accepted Feb 22, 2008.
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