Application of the Pecarn Prediction Rule for Febrile Infants up to 90 Days of Age: A Multi- Center Study

Abstract

Background Prediction rules using biomarkers to stratify young febrile infants at low risk for bacterial infections have been developed over the last decade in North America and Europe. The aim of this study was to validate the Pediatric Emergency Care Applied Research Network (PECARN) prediction rule for febrile infants 90 days of age and younger presenting to the emergency department (ED) in tertiary care centers in Saudi Arabia. Methods A multi-center retrospective study was conducted on febrile infants who presented to the ED at 3 Saudi hospitals between January 2018 and June 2021. Patients were included if they were full-term, 0–90 days of age, had documented fever, and procalcitonin (PCT) performed. Results A total of 327 patients met inclusion criteria. Fifty-three patients (16.2%) had SBIs, 33 with UTI alone and 20 invasive bacterial infections (IBIs) (bacteremia and/or bacterial meningitis). The mean absolute neutrophil count was 6.6 x 10⁹/L in infants with SBIs as compared to 4.3 x 10⁹/L in infants without SBIs (p = 0.0015). The mean PCT was 8.7 ng/mL in those with SBIs versus 0.5 ng/mL in those without SBIs (p < 0.0001). Nine patients who were classified as low-risk according to the PECARN rule had SBIs; 7 were infants with UTIs and 2 were infants under 3 weeks of age with IBIs. The sensitivity and negative predictive value of the PECARN prediction rule for SBIs was 80.4% and 92.1%, respectively. Conclusions SBIs are common in our population, and the PECARN prediction rule performed well in classifying febrile infants at low risk for SBIs. The prediction rule was very accurate in ruling out IBIs, with no misclassified cases in infants 3 weeks of age and older. Our study helps validate the applicability of the PECARN prediction rule in our setting.