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Distinct patterns of postoperative fever in paediatric neurosurgery patients

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Abstract

Purpose

Postoperative fever is a common problem following neurosurgery but data on the causes among paediatric patients is sparse. In this report, we determined the incidence, causes, and outcomes of postoperative fever in paediatric neurosurgical patients (< 18 years), and contrasted the findings with an adult cohort published recently from our unit.

Methods

We recruited 61 patients who underwent 73 surgeries for non-traumatic neurosurgical indications over 12 months. A standard protocol was followed for the evaluation and management of postoperative fever. We prospectively collected data pertaining to operative details, daily maximal temperature, clinical features, and use of surgical drains, urinary catheters, and other adjuncts. Elevated body temperature of > 99.9 °F or 37.7 °C for > 48 h or associated with clinical deterioration or localising features was considered as “fever”; elevated temperature not meeting these criteria was classified as transient elevation in temperature (TET).

Results

Twenty-six patients (35.6%) had postoperative fever, more frequent than in adult patients. TET occurred in 12 patients (16.4%). The most common causes of fever were aseptic meningitis (34.6%), followed by urinary tract infections (15.4%), pyogenic meningitis, COVID-19, and wound infections. Postoperative fever was associated with significantly longer duration of hospital admission and was the commonest cause of readmission.

Conclusion

In contrast to adults, early temperature elevations in paediatric patients may portend infectious and serious non-infectious causes of fever, including delayed presentation with aseptic meningitis, a novel association among paediatric patients. Investigation guided by clinical assessment and conservative antibiotic policy in keeping with the institutional microbiological profile provides the most appropriate strategy in managing paediatric postoperative fever.

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Data availability

The datasets generated during and analysed during the current study are available from the corresponding author on reasonable request.

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Funding

 No funding was received to assist with the preparation of this manuscript.

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Authors and Affiliations

  1. Section of Neurosurgery, Department of Neurosciences, Christian Medical College, Vellore, 632004, Tamil Nadu, India

    Abhijit Goyal-Honavar, Annsmol P. Markose, Ankush Gupta, Gandham Edmond Jonathan, Krishna Prabhu & Ari G. Chacko

  2. Department of Infectious Diseases, Christian Medical College, Vellore, Tamil Nadu, India

    Abi Manesh & George M. Varghese

  3. Department of Paediatric Infectious Diseases, Christian Medical College, Vellore, Tamil Nadu, India

    Winsley Rose

Authors
  1. Abhijit Goyal-Honavar
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  3. Ankush Gupta
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  4. Abi Manesh
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  5. George M. Varghese
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  8. Krishna Prabhu
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Contributions

AGH, APM, AG, AM, GMV, WR, GEJ, AGC, and KP conceived the protocol and design of the study. AGH and APM wrote the main manuscript text. AG, AM, GMV, WR, GEJ, AGC, and KP critically reviewed the manuscript. All authors reviewed the manuscript. 

Corresponding author

Correspondence to Krishna Prabhu.

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Ethical approval

The study was approved by the Institutional Review Board (IRB Min. No. 12914 dated 24.06.2020). Written informed consent was obtained from the patient guardians as all patients were aged under 18 years of age.

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The authors declare no conflict of interest.

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Goyal-Honavar, A., Markose, A.P., Gupta, A. et al. Distinct patterns of postoperative fever in paediatric neurosurgery patients. Childs Nerv Syst (2024). https://doi.org/10.1007/s00381-024-06355-2

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