Variation in management of febrile infants younger than 90 days across London: a retrospective cohort study

Evaluate variation in care of febrile infants presenting to London hospitals and adherence to national Clinical Practice Guidelines (CPGs). Retrospective multicentre cohort study conducted at 21 London hospitals. Infants ≤ 90 days of age presenting with fever or caregiver reported fever between 1st April 2021-31st March 2022 were included. Outcome measures were variations in patient management and adherence to national CPGs. Of 2,008 presentations, 41.1% were febrile during assessment. 73.7% had blood tests (range across hospital sites: 55.4-96.7%), 40.8% had cerebrospinal fluid (CSF) testing (17.1-70.7%), 63.4% had urinalysis (43.4-85.4%) and 62.2% were investigated for SARS-CoV2 (26.5-91.7%). Antibiotics were started in 57.7% (35.4-90.2%) and 63.5% (46.7-99.2%) were admitted. Infants aged < 28 days and infants febrile during assessment were more likely to undergo investigations and be admitted. Adherence varied significantly across sites: full adherence to CPGs was achieved in 21.9% (site range 8.8-35.4%), partial adherence in 24.4% (18.0-35.3%), non-adherence in 31.2% (10.6-47.4%), and over-adherence in 23.5% (8.0-44.7%). CPG adherence was higher in infants aged < 28 days.Conclusions: There was wide variation in care across London hospitals with limited adherence to guidelines. This highlights the need to focus on refining and updating decision models and CPGs, with more specific recommendations for managing infants who are afebrile during initial assessment. Clear guidance with a focus on reducing missed diagnosis may impact patient safety and economical expenditure.

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Publication Details

Journal
European Journal of Pediatrics
Published
2026-05-08
DOI
https://doi.org/10.1007/s00431-026-06938-y
Primary Topic
Pediatric Urology and Nephrology Studies
Type
article
Field-Weighted Citation Impact
0.00

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article

Variation in management of febrile infants younger than 90 days across London: a retrospective cohort study

Eva Loucaides, Naomi Lin, Alexia Álvarez, Marnie Bruce et al.
European Journal of Pediatrics
Pediatric Urology and Nephrology Studies
article

Variation in management of febrile infants younger than 90 days across London: a retrospective cohort study

Eva Loucaides, Naomi Lin, Alexia Álvarez, Marnie Bruce, Shirin Beebeejaun, Hamish Robertson, Christine Hesketh, Dominic Carr, Trisha Radia, Ajith Prasad, Saiqua Raoof, Nilanjana Ray, Rosie Crane, R Clubb, Noha Heikal, Basma Haroun, Rhys Dore, Nana Palm, Elizabeth O'Mahoney, Sara Farhat Dominguez, Mehreen Farooqi, Neave Kissane, Louiza Kontara, Jessica Roberts, Andres Almario, Stephanie Habermann, Gbemiga Adeoye, Ramlah Mehmood, Maggie Nyirendra, Demetris Ioannides, Alexia Prol Alvarez, Erin Hart, Sally-Ann Delaney, Nadja Bednarczuk, Rose Hartzenberg, Omar Elsawi, Valerie Milton, May Ko, Neelakshi Ghosh, Demetris Athanasiou, Zhia Lim, Elizabeth Fitchett, Cheryl Lau, Burcu Ozen, Nadia Audhali, Sarah Brown, Michelle Maria, Misbah Khan, Krizstina Kiss, Sasha Howard, Claire Girdler, Raj Radhakirshnan, Aderonke Evbuomwan, Mohammad Alam, Sandy Alatzoglou, Gregory Landon, Cheryl Lim, Jo O’Sullivan, Ashley Ong, Daniel Langer, Claire Mulvenaa, Konstantina Papagianni, Robert Legg, Abdifatah Mohamud, Michelle D’Souza, Ian Maconochie, The London REACH Network Collaborative, Jennifer Martin, Margherita Faulkner, Fran Neale, Sadaf Kiani, Ruud G. Nijman, Eiman Hajahmed, Conan Lundy, Emine Nebati, Yash Rajeev, Sabina Checketts, Sarah Hallett, Georgina Nukwe, Aikaterina Perogiannaki, Amy Holman, Liza Hallinan, Nasreen Kamarus, Suchika Garg, Caroline Philips, Kate Mcmonnies, Sarah Chambers, Basma Mohamed, Hannah Jacob, Nuha Gurafi, Nadia Abdulla, Alexandros Argyropoulos, Sarah Al Rawi, Evangelia Myttarakis, Vasundhara Piyadarshani, Ioannides Demetris, Humera Ali, George Lawson, Ashwin Mahtani, Soonie Patel
article en

Abstract

Evaluate variation in care of febrile infants presenting to London hospitals and adherence to national Clinical Practice Guidelines (CPGs). Retrospective multicentre cohort study conducted at 21 London hospitals. Infants ≤ 90 days of age presenting with fever or caregiver reported fever between 1st April 2021-31st March 2022 were included. Outcome measures were variations in patient management and adherence to national CPGs. Of 2,008 presentations, 41.1% were febrile during assessment. 73.7% had blood tests (range across hospital sites: 55.4-96.7%), 40.8% had cerebrospinal fluid (CSF) testing (17.1-70.7%), 63.4% had urinalysis (43.4-85.4%) and 62.2% were investigated for SARS-CoV2 (26.5-91.7%). Antibiotics were started in 57.7% (35.4-90.2%) and 63.5% (46.7-99.2%) were admitted. Infants aged < 28 days and infants febrile during assessment were more likely to undergo investigations and be admitted. Adherence varied significantly across sites: full adherence to CPGs was achieved in 21.9% (site range 8.8-35.4%), partial adherence in 24.4% (18.0-35.3%), non-adherence in 31.2% (10.6-47.4%), and over-adherence in 23.5% (8.0-44.7%). CPG adherence was higher in infants aged < 28 days.Conclusions: There was wide variation in care across London hospitals with limited adherence to guidelines. This highlights the need to focus on refining and updating decision models and CPGs, with more specific recommendations for managing infants who are afebrile during initial assessment. Clear guidance with a focus on reducing missed diagnosis may impact patient safety and economical expenditure.

European Journal of PediatricsVol. 185(6)
Imperial College Healthcare NHS Trust (GB), NIHR Imperial Biomedical Research Centre (GB), NIHR Research Delivery Network (GB)
National Institute for Health and Care Research, Imperial College London, Biomedical Research Council
Openalex Percentile: Top 6%
Pediatric Urology and Nephrology Studies
DOIOpen Access PDFOpenAlex
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