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Tran Nguyen, MD

Pediatric Hospital-Based Medicine, KP Roseville

“We’re always concerned about missing a serious bacterial infection in a young infant. At the same time, we don’t want to put the baby and parents through the challenge of a lumbar puncture or antibiotics that end up having been unnecessary.”

When an infant who’s less than 2 months old shows up with a fever, which tests are truly critical? Dr. Nguyen asked himself this question many times before embarking on a study that would ultimately address it.

“Some infections, such as a urinary tract infection, bacteremia, or meningitis, can make young babies very ill, have long-lasting disability, or be fatal,” he explains. “So it’s critical to distinguish which of the few cases are high risk and treat them promptly, without having to subject the majority of febrile infants to a potentially unnecessary battery of tests or antibiotics.”

Several published protocols have been available for some time to help identify infants at higher risk, but in Dr. Nguyen’s mind, they are far from perfect. Some require tests not universally available; others require invasive and/or painful procedures like lumbar punctures, parenteral antibiotics and hospitalization.

So in 2016, he and his team developed and implemented a new guideline called the “Roseville protocol.” This newer protocol modifies previous guidelines by adding a high-risk temperature criterion of 38.5°C for infants who are 7 to 28 days old and by allowing febrile infants 29 to 60 days old with abnormal urinalysis but reassuring complete blood cell counts to be discharged home on oral antibiotics without receiving a lumbar puncture.

In 2019, Dr. Nguyen collaborated with the KP Division of Research to conduct a retrospective study comparing the performance of the Roseville protocol to other published protocols. What they found is that the Roseville protocol is just as effective at identifying babies at high risk for infection, but that it results in fewer babies needing to have lumbar punctures, parenteral antibiotics, and hospitalizations.

“The Roseville protocol helps pediatricians better target interventions to those babies who are really most likely to benefit from them,” says Betty Suh-Burgmann, MD, chair of the Central Research Committee. “Dr. Nguyen’s research is a great example of a clinician asking a question that relates to his own clinical practice, but in the end produces an answer that is affecting not only the care of babies and their parents in KP Northern California, but nationwide.”

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