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Hosp Pediatr. 2020 Jan 8. pii: hpeds.2019-0227. doi: 10.1542/hpeds.2019-0227. [Epub ahead of print]

Association of Cough Status With Bacterial Infections in Febrile Infants.

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Department of Pediatrics, St. Christopher's Hospital for Children, Philadelphia, Pennsylvania; and.
Department of Biostatistics and.
Departments of Pediatrics and Public Health Sciences, School of Medicine and Dentistry, University of Rochester, Rochester, New York



To examine the association between cough status and bacterial infections (BIs) to more accurately stratify risk and predict BIs in febrile infants.


A retrospective cohort study was performed by identifying all infants ≤60 days old with temperature ≥38°C at an urban pediatric emergency department from 2014 to 2016. The Rochester Risk model was used to stratify risk. Cough status (with or without) was the main covariate of interest. The primary outcome was a BI, including urinary tract infection, bacteremia, or meningitis. Analyses consisted of descriptive statistics, simple and multiple regression to compare the odds of BI on the basis of cough status, as well as χ2 statistics to compare the BI rates among high-risk infants with and without cough.


Of 508 febrile infants ≤60 days old, 46 (9.1%) had a BI, 13 of which were either bacteremia or meningitis. There were no BIs among low-risk infants with a cough. The odds of BI increased progressively, peaking at 14.6 (95% confidence interval: 4.3-49.7) for high-risk infants without a cough. The adjusted odds of BI among infants with cough was 0.47 (95% confidence interval: 0.22-0.99).


In our findings, an inverse relationship is demonstrated between presence of cough and odds of BI, suggesting that cough status may be a useful marker of viral infections in febrile infants. Considering that detecting cough status is noninvasive, inexpensive, and immediately available, it represents an attractive value-based risk factor to enhance current BI prediction models.


Conflict of interest statement

POTENTIAL CONFLICT OF INTEREST: Dr Yaeger previously published an article that included a subset of patients from this study (Yaeger JP, Moore KA, Melly SJ, Lovasi GS. Associations of Neighborhood-Level Social Determinants of Health with Bacterial Infections in Young, Febrile Infants. J Pediatr. 2018;203:336–344). However, the work for this current study uses a larger sample population, involves a different research question, evaluates a different outcome, and uses different methods and statistical analyses. The data from this research were also presented as an abstract at the Pediatric Hospital Medicine Conference in July 2018. This article is being submitted only to Hospital Pediatrics and will not be submitted elsewhere while under consideration.

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