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Evaluation of meningitis risk in infants drives new RI-MUHC study

Results published in JAMA NetworkOpen may change practice for young infants with fever

SOURCE: RI-MUHC. Nearly 2 per cent of all term newborns will be brought to an emergency department (ED) for fever within their first months of life—approximately 10,000 infants in Canada alone. Around 10 per cent of these infants have urinary tract infections and have historically been considered at increased risk for bacterial meningitis, for which all guidelines recommend invasive testing and hospitalization.

Published this month in JAMA Network Open, a new study by researchers from the Research Institute of the McGill University Health Centre (RI-MUHC) and the BC Children’s Hospital may lead to changes in treatment of young infants with fever. The team led by Dr. Brett Burstein, MDCM, PhD, MPH, a clinician-scientist in Pediatric Emergency Medicine at the Montreal Children’s Hospital of the MUHC, conducted a meta-analysis of more than 25,000 newborns evaluated for fever in EDs around the world. They found that a presumptive urinary tract infection did not correlate with elevated risk of bacterial meningitis.

“These results are contrary to a dogma held for nearly 30 years, and counter to all recommendations and guidelines from around the world.”—Dr. Brett Burstein

“A positive urine test is currently considered a high-risk feature for bacterial meningitis,” says Dr. Burstein, who is a member of the Child Health and Human Development Program at the RI-MUHC. “This has meant that we have had to perform a spinal tap and hospitalize nearly 500 infants to avoid a single case of meningitis. This is obviously very anxiety-provoking for families, resource-intensive and not without its own risks.”

The strategy has been questioned, he says, for decades, but until now, no single study has been able to provide sufficiently robust data to inform and change this practice.

“This is the most comprehensive study on this topic to date. We found that infants with a presumptive urinary tract infection are in fact at no higher risk of bacterial meningitis,” says Dr. Burstein. “Our findings provide strong evidence that decisions regarding invasive testing for this infant population should not be guided by urine results. These results are contrary to a dogma held for nearly 30 years, and counter to all recommendations and guidelines from around the world. Our findings stand to change practice for many families who seek care from general practitioners and emergency physicians, as well as community and hospitalist pediatricians.”

About the study:

Read the publication on JAMA Network Open

Dr. Brett Burstein’s team found that a presumptive urinary tract infection did not correlate with elevated risk of bacterial meningitis.
Dr. Brett Burstein’s team found that a presumptive urinary tract infection did not correlate with elevated risk of bacterial meningitis.