Cerebrospinal fluid enterovirus testing may improve care of febrile neonates

November 1, 2010

Among febrile infants 56 days old or younger, those with a positive CSF enterovirus polymerase chain reaction test result had a shorter hospital length of stay than febrile infants of the same age who did not undergo such testing.

Among febrile infants 56 days old or younger, those with a positive cerebrospinal fluid (CSF) enterovirus polymerase chain reaction (PCR) test result had a shorter hospital length of stay (LOS) than febrile infants of the same age who did not undergo such testing, a recent retrospective cohort study showed.

Investigators at an urban tertiary care hospital evaluated the effect of CSF enterovirus PCR testing on LOS in 1,231 eligible infants, 361 of whom had had a CSF enterovirus PCR test. Of these 361 infants, 89 (24.7%) had a positive result.

Compared with untested infants, those who tested positive had a 26% shorter LOS; those who tested negative had an 8% longer stay-not significantly different from the LOS of untested infants.

In regard to administration of antibiotics, for infants 29 to 56 days old, a positive test result was associated with a shorter LOS only in those not previously receiving antibiotics. However, for infants 28 days old or younger who tested positive, LOS was shorter than for untested infants regardless of whether antibiotics were administered before lumbar puncture (Dewan M, et al. Arch Pediatr Adolesc Med. 2010;164[9]:824-830).

COMMENTARY

The median turnaround time for PCR testing was just over 22 hours. The researchers reported that this test time was not linked to length of stay. Still, I wonder whether immediate availability of this test would shorten length of stay further or even prevent some hospitalizations in this patient population.
-Michael Burke, MD