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A simple blood test may help detect serious bacterial infections (SBIs) like urinary tract infections and blood stream infections in young infants who come to the emergency department (ED) with fevers that have no clear cause. Researchers at Children’s Hospital Boston, collaborating with investigators at George Washington University, show that a new diagnostic marker called procalcitonin can help identify infants at high risk for SBIs while potentially reducing unnecessary and aggressive testing, medication and hospitalization in low risk infants. The study, published in the October Pediatrics, is the first to examine procalcitonin as a tool for evaluating infant fever in an emergency situation.

The researchers used a novel procalcitonin test, recently approved by the FDA, in 234 feverish babies under 3 months of age, of whom 18 percent had definite or possible SBIs confirmed by independent clinical criteria. The results showed that procalcitonin not only detected all cases of SBIs in feverous infants but proved sensitive enough to establish a threshold value that would identify infants at low risk for serious infections. Indeed, its overall performance as a single clinical marker of infection approached that of current strategies that involve a variety of laboratory tests and clinical evaluations.

In the United States, infant fever accounts for a vast majority of pediatric visits to the ED, of which up to 20 percent of cases have no identifiable cause of infection. While most turn out to be minor and self-limiting illnesses, a proportion of infants have SBIs such as bacteremia, meningitis, pneumonia or urinary tract infections. The risk is most significant in infants under 3 months of age. 

An estimated 2 million children in developing countries die each year from diarrhea, but simple zinc treatment could reduce the risk of such deaths.

Researchers reached this conclusion in a new review of studies involving more than 6,000 children of all ages.

“Our most important finding is that there is strong evidence that zinc supplementation benefits children suffering from diarrhea in developing countries, but only in infants over six months old,” said lead investigator Marzia Lazzerini, M.D. “Zinc reduces acute diarrhea duration in terms of mean duration and risk of diarrhea at given days. Zinc also reduces the duration of persistent diarrhea.”

Nearly 30 percent of children in the world are zinc deficient, Lazzerini said. She is a pediatrician with the World Health Organization (WHO) Collaborating Centre for Maternal and Child Health in Trieste, Italy.