Fever Of Unknown Origin In Neonates:Still And Dynamic Analysis, Warning Diabetes Evsipidus Shouldn’t Be Overlooked

Background:Fever of unknown origin (FUO) had been a hot issue since the first paper in 1961. To our knowledge, no series on neonatal FUO had been reported. We made one and we defined the criteria of neonatal FUO in order to serve as a useful reference for further studies on FUO in neonates.Methods:A pre-survey was conducted to define neonatal FUO. Then, all patients hospitalizing at the Department of Neonatology, Children’s Hospital of Chongqing Medical University, Chongqing, China, during 2004 through 2013 were browsed and those in accordance with neonatal FUO criteria were extracted. Data on baseline characteristics, diagnosis and differences between FUO group and non-FUO group, between the former four years and the latter six years were analyzed by using the software SPSS(a=0.05).Results:Of 55,139 cases, FUO occurred in 249(4.5%o). There were 6 neonates without definite diagnosis until discharge. The rest were diagnosed with pneumonia, septicemia, meningitis/encephalitis, neonatal necrotizing enterocolitis (NEC), infectious diarrhea, common viral infections, tetanus, immunodeficiency (including one chronic granulomatous disease case), myocarditis, hepatitis, diabetes insipidus or intestinal atresia which all were risk factors for FUO (p<0.05). Of them, pneumonia, septicemia, meningitis/encephalitis, NEC played independent predictor roles (OR 3.2,3.7,17.5 and 6.1 respectively, p<0.05). For diabetes insipidus, three of four neonates underwent FUO and one neonate diagnosed with diabetes insipidus had the highest probability to suffering from FUO (75%). Compared between the former four years and the latter six years, the occurrence rate decreased from 8.8%o to 3.0%o. Proportions of septicemia and NEC increased significantly (p<0.05). More neonates diagnosed with immunodeficiency, syphilis, hepatitis and diabetes insipidus and fewer ones with common viral infections, tetanus and myocarditis were observed. As to pneumonia, meningitis/encephalitis and infectious diarrhea, no significant changes happened between these two periods (p>0.05).Conclusions:Neonatal FUO was not a rare issue and changes happened in occurrence rates and spectrum of diseases over time. Pneumonia, septicemia, meningitis/encephalitis, NEC, infectious diarrhea, common viral infections, tetanus, immunodeficiency, myocarditis, hepatitis, diabetes insipidus and intestinal atresia had significances on neonatal FUO. The first four kinds of diseases were identified as independent risk factors. Diabetes insipidus shouldn’t been overlooked because one patient had the greatest probability undergoing FUO once diabetes insipidus suspected.