International study offers new path to reduce spinal taps in young infants with fevers
New evidence from a six-country study led by the Montreal Children’s Hospital and Children’s National Hospital shows simple blood and urine tests could spare many young infants with fevers from more invasive procedures.
Washington, DC, Dec. 08, 2025 (GLOBE NEWSWIRE) -- A simple combination of blood and urine tests may allow many infants with fevers (febrile) to safely avoid lumbar punctures (spinal taps), according to new findings from a major international study published today in JAMA. The results show that these noninvasive tests can reliably identify infants with fevers 28 days and younger who are at very low risk for invasive bacterial infections.
“For more than 40 years, pediatric researchers have been trying to determine how to safely do less testing for febrile infants in the first month of life without missing uncommon, but dangerous infections,” said Brett Burstein, MDCM, PhD, MPH, lead author of the study and pediatric emergency physician at the Montreal Children’s Hospital.
Febrile infants younger than 28 days old are routinely evaluated for invasive bacterial infections such as bacterial meningitis because their early symptoms can be subtle. Most hospitals automatically perform a full infection workup, including spinal taps, then administer intravenous antibiotics, even when a febrile infant appears well.
“Fever in the first month of life is one of the highest stakes situations we face in pediatric care,” said Nathan Kuppermann, MD, MPH, senior author of the study, chief academic officer at Children’s National, a pediatric emergency physician and director of the Children’s National Research Institute. “Studying these uncommon infections really required international collaboration. Our findings show we can now use a validated, evidence-based rule to identify many of these young febrile infants who are extremely unlikely to have bacterial meningitis, which can support more personalized decisions for families.”
“Our analysis included more than 2,500 febrile infants across multiple countries and, using three widely available laboratory tests without spinal taps, performed with excellent diagnostic accuracy for ruling out invasive bacterial infections, Importantly, achieving zero missed cases of bacterial meningitis in such a large number of febrile infants in the first month of life is a critical benchmark in this area of research,” added Dr. Burstein, also a scientist in the Child Health and Human Development Program at the Research Institute of the McGill University Health Centre. “These results provide the level of evidence clinicians need to feel confident to strongly consider this approach.”
The study evaluated the performance of an updated febrile infant prediction rule from the Pediatric Emergency Care Applied Research Network (PECARN), a study for which Dr. Kuppermann served as principal investigator. The updated PECARN rule offers an evidence-based way to identify young febrile infants for whom a less invasive approach may be appropriate. The PECARN rule classifies a febrile infant as low risk if three criteria are met: The urinalysis is negative, the serum procalcitonin level is at or below 0.5 ng/mL and the absolute neutrophil count is at or below 4,000 per mm³. The rule does not require a spinal tap to determine risk and relies only on blood and urine tests routinely used in emergency departments worldwide.
Among the 2,531 infants from four international cohorts and the two US-based cohorts from which the PECARN rule was originally derived, the rule demonstrated a sensitivity of 94.8% and a negative predictive value of 99.6% for ruling out all invasive bacterial infections. Most importantly, none of the 22 cases of bacterial meningitis were missed among infants classified as low risk.
Families with questions about how fever is evaluated in young infants should speak with their physicians. Clinical decisions for infants 28 days and younger remain individualized and should be guided by pediatric experts.
Children’s National media contact: Media@childrensnational.org | (202) 476-4500
The Montreal Children’s Hospital media contact: christine.bouthillier@muhc.mcgill.ca | (514) 922-5696
###
About Children’s National Hospital
Children’s National Hospital, based in Washington, D.C., was established in 1870 to help every child grow up stronger. Today, it is one of the top 10 children’s hospitals in the nation and ranked in all specialties evaluated by U.S. News & World Report. Children’s National is transforming pediatric medicine for all children. The Children’s National Research & Innovation Campus opened in 2021, a first-of-its-kind pediatric hub dedicated to developing new and better ways to care for kids. Children’s National has been designated four times in a row as a Magnet® hospital, demonstrating the highest standards of nursing and patient care delivery. This pediatric academic health system offers expert care through a convenient, community-based primary care network and specialty care locations in the D.C. metropolitan area, including Maryland and Virginia. Children’s National is home to the Children’s National Research Institute and Sheikh Zayed Institute for Pediatric Surgical Innovation. It is recognized for its expertise and innovation in pediatric care and as a strong voice for children through advocacy at the local, regional and national levels. In 1987, Children’s National founded Safe Kids Worldwide, a non-profit dedicated to reducing unintentional injuries among children through comprehensive national and global education, research and advocacy. As a non-profit, Children's National relies on generous donors to help ensure that every child receives the care they need.
For more information, follow us on Facebook, Instagram and LinkedIn.
About the Montreal Children’s Hospital
Established in 1904, the Montreal Children's Hospital is Quebec’s oldest children’s hospital and the pediatric hospital of the McGill University Health Centre (MUHC). A tertiary and quaternary care teaching and research facility, treating newborns, children and adolescents up to age 18, it serves 63 per cent of the geographic population of Quebec.
With its pediatric care and research facilities adjacent to the adult facility on the Glen site, the Children’s is in a unique position to offer services and research across the lifespan. The Centre for Innovative Medicine - one of the Research Institute of the McGill University Health Centre’s research facilities and the only clinical research centre in a hospital setting in North America – allows its researchers to conduct clinical trials on the hospital site.
The Montreal Children's Hospital is a leader in providing a broad spectrum of highly specialized care to young patients and families from all across Quebec. The hospital is a provincially designated trauma centre and is recognized for its wealth of expertise in cardiology and cardiac surgery, emergency care, neurology and neurosurgery. montrealchildrenshospital.ca
Media Children's National Hospital 2024764500 Media@childrensnational.org
Legal Disclaimer:
EIN Presswire provides this news content "as is" without warranty of any kind. We do not accept any responsibility or liability for the accuracy, content, images, videos, licenses, completeness, legality, or reliability of the information contained in this article. If you have any complaints or copyright issues related to this article, kindly contact the author above.
