Hyperpyrexia and high fever as a predictor for serious bacterial infection (SBI) in children—a systematic review

Abstract

It is not clear if children with high fever are at increased risk for serious bacterial infection (SBI). Our aim was to systematically review if children suffering from high fever are at high risk for SBI. Our data sources were Embase, Medline, and Pubmed; from their inception until the last week of March 2017. The study selection were of cohort and case control studies comparing the incidence of SBI in children with hyperpyrexia with children with fever of 41 °C or less, and children with a temperature higher than 40 °C, with children with fever of 40 °C or less. Two reviewers independently pooled studies for detailed review using a structured data-collection form. We calculated the odds ratio and 95% confidence intervals (CI) for SBI, assuming a random-effects model. A sub-group analysis was conducted. In our results, 11 studies met the inclusion criteria. Two studies showed that children with hyperpyrexia are at higher risk for SBI (OR 1.96 95% CI 1.3–1.97). An increased risk for SBI in children with high fever (OR 3.21 95% CI 1.67; 6.22). SBI in infants with temperature over 40 °C was higher compared to infants with lower degree of fever (OR 6.3 95% CI 4.44; 8.95). On older children, the risk for SBI was only slightly higher in children with fever above 40 °C. The limitation of the study is the small amount of studies and that the heterogeneity of the studies was very high.

Conclusion: Young infants with temperature higher than 400 °C are at increased risk for SBI. Risk of SBI in older children with temperature > 400C is minimal.

What is known:
• An association between high fever and increased risk for SBI was reported in young infants.
• Based on only two studies from the 1970s and 1980s, hyperpyrexia is associated with increased risk for SBI.
What is new:
• Infants under the age of 3 months with fever > 40 °C were found to have increased risk for SBI.
• Risk of SBI in older children with temperature > 40 °C is minimal.

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Abbreviations

CI:

Confidence intervals

GE:

Gastorenteritis

fever > 41 °C:

Hyperpyrexia

SBI:

Serious bacterial infection

UTI:

Urinary tract infection

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Authors

Contributions

Dr. Rosenfeld-Yehoshua conceptualized and designed the study, wrote the manuscript, and approved the final manuscript as submitted.

Dr. Barkan and Dr. Abu-Kishk carried out the initial analyses, reviewed and revised the manuscript, and approved the final manuscript as written.

Booch and Suhami substantially contributed to the conception and design of the study and approved the final manuscript as submitted.

Dr. Kozer designed the data collection instruments, coordinated, supervised data collection, critically reviewed the manuscript, and approved the final manuscript as submitted.

Corresponding author

Correspondence to Noa Rosenfeld-Yehoshua.

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The authors declare that they have no conflicts of interest.

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This article does not contain any studies with human participants or animals performed by any of the authors

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Communicated by Nicole Ritz

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Rosenfeld-Yehoshua, N., Barkan, S., Abu-Kishk, I. et al. Hyperpyrexia and high fever as a predictor for serious bacterial infection (SBI) in children—a systematic review. Eur J Pediatr 177, 337–344 (2018). https://doi.org/10.1007/s00431-018-3098-x

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Keywords

  • High fever
  • High temperature
  • Hyperpyrexia
  • Infant
  • High fever
  • Serious bacterial infection (SBI)
  • High temperature
  • SBI
  • Pneumonia
  • Pyelonephritis
  • UTI
  • Meningitis
  • Pediatric
  • Infant