0843 More on triage for admission in first two months of life

Summary 0803 deals with the issue of appropriately identifying young infants for hospitalisation with sufficient specificity and confidence to avoid missing even a few. The information in that report was derived from the international multicentre Young Infant Study(YIS) of ±9000 infants, with South Africa contributing data from a site in KwaZulu Natal (KZN). Seven signs were shown to be adequately predictive of serious illness in infants of <60 days of age; temp >37,5 or <35,5, feeding difficulties, convulsions, movement only on stimulation, tachypnoea <60/min, and retractions. Of particular note was an editorial comment that highlighted the low sensitivity of the results as applied to the South African site (50-60%), i.e. if the system as published were to be applied to South African infants there was a chance of missing an unacceptably high number of infants. The KZN investigators recently published results on their contributing 925 infants, reporting that hyperbilirubinaemia and sepsis were the leading problems in the first week of life; pneumonia, hyperbilirubinaemia and sepsis between the first week and end of first month; and pneumonia and sepsis thereafter. They comment specifically on the importance of feeding difficulties, fever, tachypnoea and retractions as useful predictors of severe illness, but do not address the issue of low sensitivity and the number of children hospitalised with severe illness but lacking these signs. A key table in the paper gives results for admissions based on the YIS criteria but specifically excludes admissions for jaundice, suggesting perhaps that this is a category of urgent admissions that was unique to KZN and/or South Africa, and that is not detected by the YIS triage system.

Read more:
South Afr J Med 2008; 98: 883-888
Lancet 2008; 371: 135-42
Pediatr Infect Dis J 2003; 22: 711-16