Neonatal Fever in the Emergency Department A Retrospective Study

Purpose: This study aimed to assess the epidemiology and diagnosis of severe bacterial infections in febrile neonates brought to the emergency department. Methods: We conducted a retrospective review of medical records from neonates aged 28 days or younger admitted for fever to the emergency department of a Belgian tertiary hospital between January 2020 and December 2022. Results: Among 190 febrile neonates, 17 (9%) were diagnosed with a severe bacterial infection. Most were urinary tract infections (15 cases), mainly caused by Escherichia coli . Four neonates (2%) had invasive bacterial infections: one Pseudomonas aeruginosa meningitis, one Staphylococcus aureus bloodstream infection, and two urinary tract infections with concomitant bacteremia. Twelve of the 17 pathogens (71%) showed resistance to at least one antibiotic. Three neonates with severe bacterial infections, including two with invasive disease, had a CRP level below 10 mg/L at admission. Male neonates were at higher risk of bacterial infection. Conclusion: Severe bacterial infections were less frequent than expected, with Escherichia coli urinary tract infections predominating. CRP was not a reliable marker for invasive disease. These findings support a targeted and individualized approach to antibiotic use and suggest that, in neonates older than 21 days with reassuring initial evaluation, close follow-up may be considered over systematic lumbar puncture.