Febrile infants in the emergency department of a public hospital in India: respiratory infections lead the pack


  • Pragyan Pradhan Department of Pediatrics, Maulana Azad Medical College, New Delhi, India
  • Devendra Mishra Department of Pediatrics, Maulana Azad Medical College, New Delhi, India
  • Monica Juneja Department of Pediatrics, Maulana Azad Medical College, New Delhi, India
  • Surinder Kumar Department of Microbiology, Maulana Azad Medical College, New Delhi, India




Etiology, Mortality, Outcome, Symptoms


Background: The objective of study was to find the etiology, signs and symptoms of fever of 4-7 days in the age group of 91 days 2 years and their outcome following treatment in a tertiary care hospital.

Methods: This was a prospective study conducted at the Emergency Department (ED) of a public hospital in New Delhi between April, 2018 and January, 2019. 150 children aged 3 months to 2 years with 4-7 days of fever were included. Demographic, clinical and diagnostic data were collected, and children were managed using ACEE-INDIA guidelines, telephonic follow-up was done for those discharged from ED.

Results: Out of 150 children, respiratory tract infections were most common etiological group (64%), followed by gastrointestinal infections (16.7%) and CNS infections (9.3%). Fever with cough (with respiratory distress-27.3%) was the most common symptom in these children. Overall, 61% were admitted; majority (58%) being with respiratory problems. Median (IQR) duration of stay in admitted children was 2 (0, 3) days. Mortality was observed in 12 (8%) children. Mortality was 4 times higher in children with CNS infections as compared to other conditions [RR=4.14 (1.4 to 12.4); P=0.01].

Conclusions: Fever in the ED among Indian infants at a public hospital was mainly due to respiratory infection, which could be managed on outpatient-basis in the majority using the ACEE-INDIA (Academic College of Emergency Experts in India) guidelines. However, among those admitted, neurological conditions were the most common cause of death.


de Bont EG, Lepot JM, Hendrix DA, Loonen N, Guldemond-Hecker Y, Dinant GJ, et al. Workload and management of childhood fever at general practice out-of-hours care: an observational cohort study. BMJ open. 2015;5(5):e007365.

Muth M, Statler J, Gentile DL, Hagle ME. Frequency of fever in pediatric patients presenting to the emergency department with non-illness-related conditions. J Emerg Nurs. 2013;39(4):389-92.

Sands R, Shanmugavadivel D, Stephenson T, Wood D. Medical problems presenting to paediatric emergency departments: 10 years on. Emerg Med J. 2012;29(5):379-82.

Whitburn S, Costelloe C, Montgomery AA, Redmond NM, Fletcher M, Peters TJ, et al. The frequency distribution of presenting symptoms in children aged six months to six years to primary care. Primary health care res & develop. 2011;12(2):123-34.

Finkelstein JA, Christiansen CL, Platt R. Fever in pediatric primary care: occurrence, management, and outcomes. Pediatr. 2000;105(2):260-6.

Bruijnzeels MA, Foets M, van der Wouden JC, van den Heuvel WJ, Prins A. Everyday symptoms in childhood: occurrence and general practitioner consultation rates. Br J Gen Pract. 1998;48(426):880-4.

Mahajan P, Batra P, Thakur N, Patel R, Rai N, Trivedi N, et al. Consensus Guidelines on Evaluation and Management of the Febrile Child Presenting to the Emergency Department in India. Ind Pediatr. 2017;54(8):652-60.

Mishra D, Singh HP. Kuppuswamy's socioeconomic status scale a revision. Indian J Pediatr. 2003;70:273-4.

Luszczak M. Evaluation and management of infants and young children with fever. Am Fam Physi. 2001;64:1219-26.

Standard Treatment Guidelines : A Manual For Medical Therapeutics: B.I. Publications Pvt. Limited. 2008.

Pradhan P, Mishra D. Comparison of domicilary and hospital-measured temperature amongst febrile infants presenting to an emergency department. Indian Pediatr. 2020;57(12):1178-80.

Ashworth A. Nutrition, food security, and health. In: Kliegman RM, Stanton BF, St Geme JW, Schor NF. Nelson Textbook of Pediatrics. 20th ed. Philadelphia: Elsevier. 2016;295-306.

Thota S, Ladiwala N, Sharma PK, Ganguly E. Fever awareness, management practices and their correlates among parents of under five children in urban India. Int J Contemp Pediatr. 2018;5(4):1368-76.

Ocheke IE, Thandi P. Malnutrition in acutely ill children at the paediatric emergency unit in a tertiary hospital in Nigeria. Niger Med J. 2015;56(2):113-7.

India. Ministry of Health and Family Welfare. International Institute for Population Sciences. India Fact Sheet. NFHS-4. Mumbai. 2015-16.

Devarajulu K, Velusamy P. A study of etiology, clinical profile and outcome in children aged 1-12 years presenting with fever of 1-3 weeks duration in a tertiary hospital. Int J Contemp Pediatr. 2019;6:569-73.

Vikram K, Vanneman R, Desai S. Linkages between maternal education and childhood immunization in India. Soc Sci Med. 2012;75(2):331-9.

Desai S, Alva S. Maternal education and child health: is there a strong causal relationship? Demogra. 1998;35(1):71-81.

Nischal T, Bhattacharya M. Utilization of Immunization Services in Two Districts of Haryana: Beneficiaries' Perspective. Health and Population- Perspectives and Issues. 2013;36:45-56.

Forshaw J, Gerver SM, Gill M, Cooper E, Manikam L, Ward H. The global effect of maternal education on complete childhood vaccination: a systematic review and meta-analysis. BMC Infect Dis. 2017;17(1):801.

Gohar U, Khubaib S, Mehmood A. Self-Medication Trends in Children by their Parents. J Develop Drugs. 2017;6(2):1-7.

Naaraayan S, Rathinabalan I, Seetha V. Self-medication pattern among children attending a tertiary hospital in South India: a cross-sectional study. Int J Contemp Pediatrics. 2016;1267-71.

Mohanna M. Self-medication with Antibiotic in Children in Sana'a City, Yemen. Oman Med J. 2010;25(1):41-3.

Limaye D, Limaye V, Fortwengel G, Krause G. Self-medication practices in urban and rural areas of western India: a cross sectional study. Int J Community Med Public Health. 2018;5:2672-85.

Hay AD, Heron J, Ness A, ALSPAC study team. The prevalence of symptoms and consultations in pre-school children in the Avon Longitudinal Study of Parents and Children (ALSPAC): a prospective cohort study. Fam Pract. 2005;22(4):367-74.

Armon K, Stephenson T, Gabriel V, MacFaul R, Eccleston P, Werneke U, et al. Determining the common medical presenting problems to an accident and emergency department. Arch Dis Child. 2001;84(5):390-2.

Santhanam I, Pai M, Kasturi K, Radhamani MP. Mortality after admission in the pediatric emergency department: a prospective study from a referral children's hospital in southern India. Pediatr Crit Care Med. 2002;3(4):358-63.

Mistry RD, Stevens MW, Gorelick MH. Short-term outcomes of pediatric emergency department febrile illnesses. Pediatr Emerg Care. 2007;23(9):617-23.

Sands R, Shanmugavadivel D, Stephenson T, Wood D. Medical problems presenting to paediatric emergency departments: 10 years on. Emerg Med J. 2012;29(5):379-82.

Salaria M, Singhi SC. Profile of patients attending pediatric emergency service at Chandigarh. Indian J Pediatr. 2003;70(8):621-4.

Bereznicki BJ, Tucker MG, Beggs SA, Zosky GR, Bereznicki LR. Emergency department presentations of febrile children to an Australian public hospital. J Paediatr Child Health. 2018;54(12):1308-13.

Costa de Santana M, Duarte Mello Amoedo C, Nascimento-Carvalho CM. Clinical and epidemiological characteristics of children admitted with fever in emergency department with or without sepsis. J Infect Dev Ctries. 2017;11:597-603.

Singh R, Koonwar S, Verma S, Kumar R. Spectrum of Paediatric Emergency at a Tertiary Care Public Hospital in Northern India: Application of WHO-ETAT Triage Guidelines and Predictors of 24 hour Mortality. J of Gen and Emerg Med. 2017;2(3):1-5.

Singhi S, Gupta G, Jain V. Comparison of pediatric emergency patients in a tertiary care hospital vs a community hospital. Ind Pediatr. 2004;41(1):67-72

Jofiro G, Jemal K, Beza L, Bacha Heye T. Prevalence and associated factors of pediatric emergency mortality at Tikur Anbessa specialized tertiary hospital: a 5 year retrospective case review study. BMC Pediatr. 2018;18(1):316.

Singhi S, Jain V, Gupta G. Pediatric emergencies at a tertiary care hospital in India. J Trop Pediatr. 2003;49(4):207-11.

Elfving K, Shakely D, Andersson M, Baltzell K, Ali AS, Bachelard M, et al. Acute uncomplicated febrile illness in children aged 2-59 months in Zanzibar-aetiologies, antibiotic treatment and outcome. PLoS one. 2016;11(1):e0146054.






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