Distinct patterns of postoperative fever in paediatric neurosurgery patients

Purpose: Postoperative fever is a common problem following neurosurgery but data on the causes among paediatric patients is sparse. In this report, we determined the incidence, causes and outcomes of postoperative fever in paediatric neurosurgical patients (<18 years), and contrasted the findings with an adult cohort published recently from our unit. Methods: We recruited 61 patients operated for non-traumatic neurosurgical indications over 12 months. A standard protocol was followed for the evaluation and management of postoperative fever, collecting data regarding operative details, daily maximal temperature, clinical features, and use of surgical drains, urinary catheters, and other adjuncts. Elevated body temperature of >99.9°F or 37.7°C for >48 hours or associated with clinical deterioration or localising features was considered as “fever”; elevated temperature not meeting these criteria were classified as transient elevation in temperature (TET). Results: Twenty-five patients (34.2%) had postoperative fever, more frequent than in adult patients. TET occurred in 12 patients (16.4%). The most common causes of fever were aseptic meningitis (36%), followed by urinary tract infections (16%), pyogenic meningitis, COVID-19 and wound infections. Postoperative fever was associated with significantly longer duration of hospital admission and was the commonest cause of readmission. Conclusion: In contrast to adults, early temperature elevations in paediatric patients may portend infectious and serious non-infectious causes of fever, including delayed presentation with aseptic meningitis, a novel association among paediatric patients. Investigation guided by clinical assessment and conservative antibiotic policy in keeping with the institutional microbiological profile provide the most appropriate strategy in managing paediatric postoperative fever.