Editor’s Note: Dr. Ella Perrin (she/her/hers) is a resident physician in pediatrics at Naval Medical Center San Diego. Her interests include disordered eating, obesity, decreasing weight stigma and bias, and the field of hospital medicine. The views expressed in this blog are those of the author and do not necessarily reflect the official policy or position of the Department of the Navy, Department of Defense, or the US Government. Dr. Perrin declares no conflicts of interest.
-Rachel Y. Moon, MD, Associate Editor, Digital Media, Pediatrics
The well-appearing febrile neonate is commonly seen in emergency department (ED) settings. While it is a routine chief complaint, management can involve multiple procedures (including lumbar puncture) and hospital admission to rule out invasive bacterial infection.
These interventions can be stressful for parents and associated with iatrogenic risks, such as exposure to infections during hospitalization.
Guidelines have been developed to risk-stratify febrile neonates to minimize unnecessary interventions. These guidelines have been updated as disease epidemiology has changed and we learn more about the risk of invasive bacterial infection in different age groups. The most recent guidelines published by the American Academy of Pediatrics allows room for shared-decision making (SDM) in the management of certain infants >21 days old.
However, in order to engage in SDM, providers must understand parental expectations, perceptions regarding treatment options, and preferences.
In an article and accompanying video abstract being early released this week in Pediatrics, entitled “Parental Preferences and Shared Decision-Making for the Management of Febrile Young Infants,” Dr. Philippe Sylvestre and colleagues from Université de Montréal, McGill University, Yale University, and University of British Columbia sought to identify parental expectations and preferences for the care of their well-appearing febrile infant (10.1542/peds.2024-066420).
Parents of infants ≤60 days old presenting to a single urban pediatric ED with a fever were invited to complete a telephone questionnaire within 30 days of ED or hospital discharge and participate in a video focus group regarding their ED experience and expectations.
Quantitative data obtained from the questionnaire demonstrated that:
- The need for hospitalization and lumbar puncture were the least anticipated aspects of care (20.8% and 10.2%, respectively).
- For those parents whose infants needed hospitalization or lumbar puncture, these were also the most stressful aspects of care.
- Almost all parents (97.5%) wanted to be involved in medical decision-making, and 97% felt they received enough information and had their questions answered in the ED.
Qualitative data from video focus groups found that:
- If there was a strong medical recommendation, parents preferred to follow that recommendation from the medical team.
- If there were multiple reasonable management options, parents preferred to engage in SDM.
- Parents wanted to engage in discussions regarding their infants’ care, regardless of their desire for SDM.
- Many parents felt statistics were overwhelming in the acute setting.
- Empathy, individualized care, and consistent updates (including having time to prepare for procedures and decisions) were important in decreasing stress.
This study provides many insights into the ED experience of families of febrile neonates. My biggest takeaways are that lumbar puncture and hospitalization are the most unanticipated and stressful aspects of care for parents, early and frequent communication can mitigate this stress, and that I should provide a balance of SDM and informed consent based on the strength of my medical recommendation for that particular child and their family’s desired involvement.
I urge all pediatric clinicians to read this article to better understand the experience of families of febrile infants in the ED, so we can best support them and mitigate excess worry during what can be a very frightening experience.
