A chest radiograph is indicated in neonates with FWS and respiratory symptoms [3,21]. In addition, a chest radiograph in a septic-appearing neonate with FWS may disclose an occult pneumonia [6,8,16,28]. Some investigators advocate routine chest radiographs in all neonates with FWS because these infants are relatively immunocompromised compared with older infants and children, and the consequences of a missed SBI or occult infection are felt to be greater [6]. A chest radiograph can help exclude congenital or acquired cardiac disease in a child who is febrile and ill. However, the benefit of routine use of chest radiography in neonates without respiratory symptoms has not been established [3,21]. Bramson et al [43] combined their data with those of 2 prior studies [42,47] and subjected these to a statistical meta-analysis. The larger number of patients in the combined study allowed more valid conclusions concerning the accepted practice of performing chest radiographs in febrile infants as part of the sepsis workup. These 3 series had 671 infants. In 361 infants with no clinical evidence of pulmonary disease on history and physical examination, all had normal chest radiographs. A finding of only hyperinflation on a chest radiograph was interpreted as normal because it was felt that the infants would likely have a viral illness or reactive airway disease and would not usually be receiving antibiotics, unlike older children and adults [48]. Bramson et al [43] indicated that a chest radiograph in a patient with no pulmonary symptoms or signs would be positive <1.2% of the time. In the current era of S. pneumonia and H. flu vaccine use, this rate might fall even further. Murphy et al [49] found an incidence of radiographic pneumonia in 5.3% of 2,128 children under 10 years of age with no lower respiratory symptoms (other than cough) and concluded that there was a low utility in obtaining chest radiographs in febrile children without cough.
Fever Without Source or Unknown Origin Child. A chest radiograph is indicated in neonates with FWS and respiratory symptoms [3,21]. In addition, a chest radiograph in a septic-appearing neonate with FWS may disclose an occult pneumonia [6,8,16,28]. Some investigators advocate routine chest radiographs in all neonates with FWS because these infants are relatively immunocompromised compared with older infants and children, and the consequences of a missed SBI or occult infection are felt to be greater [6]. A chest radiograph can help exclude congenital or acquired cardiac disease in a child who is febrile and ill. However, the benefit of routine use of chest radiography in neonates without respiratory symptoms has not been established [3,21]. Bramson et al [43] combined their data with those of 2 prior studies [42,47] and subjected these to a statistical meta-analysis. The larger number of patients in the combined study allowed more valid conclusions concerning the accepted practice of performing chest radiographs in febrile infants as part of the sepsis workup. These 3 series had 671 infants. In 361 infants with no clinical evidence of pulmonary disease on history and physical examination, all had normal chest radiographs. A finding of only hyperinflation on a chest radiograph was interpreted as normal because it was felt that the infants would likely have a viral illness or reactive airway disease and would not usually be receiving antibiotics, unlike older children and adults [48]. Bramson et al [43] indicated that a chest radiograph in a patient with no pulmonary symptoms or signs would be positive <1.2% of the time. In the current era of S. pneumonia and H. flu vaccine use, this rate might fall even further. Murphy et al [49] found an incidence of radiographic pneumonia in 5.3% of 2,128 children under 10 years of age with no lower respiratory symptoms (other than cough) and concluded that there was a low utility in obtaining chest radiographs in febrile children without cough.