Pediatric Academic Societies Abstracts for 2001

OTITIS MEDIA IN FEBRILE INFANTS 0-3 MONTHS OLD; MANAGEMENT AND OUTCOME IN OFFICE SETTINGS S Shochet, TB Newman, J Takayama, RC Wasserman and R Pantell. General Pediatrics, University of California, San Francisco, CA; and Pediatric Research in Office Settings (PROS), Center for Child Health Research, American Academy of Pediatrics, Elk Grove Village, IL. Accepted for a platform presentation at the 2001 Pediatric Academic Societies? Annual Meeting.

OBJECTIVE: To determine primary care practitioner diagnosis and management of OM in young febrile infants and associated outcomes.

DESIGN/METHODS: A prospective cohort study of 3066 febrile (T>= 38.0°) infants <=3 months old presenting to 577 primary care practitioners in the PROS Febrile Infant Study. Practitioners recorded impressions, management, and follow-up to resolution of illness. OM is defined as impression/finding of OM on initial exam.

RESULTS: OM was diagnosed in 14% of infants (7% of 1 month, 13% of 1-2 month, and 21% of 2-3 month olds). Infants with and without OM had similar mean temperatures (38.7° vs. 38.6°), and appearance (at least moderately ill 26% vs. 28%). The table compares management and associated serious bacterial illness rates between infants with and without OM. Odds ratios (AOR) are adjusted for age, temperature, and clinical appearance.

	OM (%)	No OM (%)	AOR (95%CI)
Blood test	60	77	.54 (.43-.69)
Urine test	33	62	.33 (.26-.42)
Lumbar puncture	18	36	.48 (.36-.65)
Hospitalized, day 1	18	30	.53 (.40-.73)
UTI (if tested)	5.0	9.6	.50 (.22-1.2)
Bacteremia (if tested)	3.1	3.0	1.2 (.49-2.8)
Meningitis (if LP)	1.3	1.4	1.1 (.14-8.9)

Sixty-three percent of infants with OM received oral antibiotics (45% if 0-1 month, 50% if 1-2 months, 77% if 2-3 months). Only 43%(22/51) of infants <=1 month with OM were hospitalized. Delayed hospitalization occurred in 1% (4/364) of infants with OM and in 1% (20/1951) of infants without OM; among the 4 infants with OM, 3 had bronchiolitis and 1 had Strep pyogenes bacteremia which resolved without serious complications.

CONCLUSIONS: OM is frequently diagnosed in very young infants. Although management is less extensive, with careful follow-up, serious complications appear rare.