107 - Clinical Outcomes for Febrile Infants with Sickle Cell Disease: A Single Center Retrospective Review of Admissions Practices

Publication Number: 107.4529

Katie S. Stoops, University of Tennessee Health Science Center College of Medicine, Memphis, TN, United States; Clifford Takemoto, St. Jude Children's Research Hospital, Memphis, TN, United States; Rohith Jesudas, SJCRH, Memphis, TN, TN, United States; Amanda Green, St. Jude Children's Research Hospital, Memphis, TN, United States

Background: Children with sickle cell disease (SCD) are at high risk of invasive bacterial infection. It is recommended that these patients present for medical evaluation with every fever. Criteria for admission in the setting of fever vary widely among institutions, and it is common practice to admit all febrile children with SCD who are < 12 months of age. However, there is a paucity of data regarding the true risk of invasive bacterial infections in the era of pneumococcal vaccination and routine use of hydroxyurea.

Objective: As an institution with no guidelines mandating admission of febrile patients with SCD < 12 months, we aimed to examine the rates of admission, representation, and diagnoses of interest as a means of establishing the safety of discharging well-appearing infants with SCD.

Design/Methods: We conducted a retrospective review of our Sickle Cell Clinical Research and Intervention Program (SCCRIP) database to identify fever evaluations (discharge diagnosis of fever or recorded temperature >38.0°C) occurring from January 1, 2011 to December 31, 2021. We conducted statistical analysis of admission rates, reevaluations within 7 days, and discharge diagnoses amongst patient subgroups defined as: infants < 12 months, preschool 12-60 months, school age 5-18 years.

Results: Of 784 patients with 4605 episodes of fever, rates of admission on initial evaluation were similar among subgroups with infants 29.9% (201/673), preschool 25.5% (533/2093), school age 31.0% (570/1839). There was no significant difference between infants and older children in the rate of 7-day return for reevaluation (11.3% vs 9.9%, p=1.00) or admission within 7 days of initial presentation (47.4% vs 44.8% of return visits, p=0.89). Viral illness was the most common diagnosis overall (18.5%, n=746). Bacteremia accounted for 0.3% (n=2) of infant febrile presentations, which was not significantly different than other subgroups (preschool: 0.76%, n=16; school age: 0.49%, n=9). However, acute chest syndrome occurred more often in the school age subgroup versus infant subgroup (13.7% vs 2.1%; p=0.003), and was less likely to be associated with a concurrent viral diagnosis (9.1% vs 28.6%; p< 0.001).

Conclusion(s): Although risk of severe invasive pneumococcal infection has been a major driver of clinical practice regarding febrile infants with SCD, no difference was seen in the rates of bacteremia in infants versus older children. Risk of other serious comorbidities of SCD may be significantly lower in infants as compared to older subgroups, arguing against mandates to admit all febrile infants with SCD to hospital.