Doctors may be missing cases of deadly bacterial meningitis in babies, a charity has warned.
The comments from the Meningitis Research Foundation (MRF) come after a new study found that classic symptoms of bacterial meningitis were uncommon among babies with the deadly illness.
Fever has long been thought of as a key symptom of bacterial meningitis but the study has found that only around half of babies under the age of three months with the disease had a fever.
Researchers from St George's, University of London, examined data on 263 babies in Britain with bacterial meningitis.
Their study, published in the Paediatric Infectious Diseases journal, found that only 54% of infants had a fever.
The MRF said that fever has been a trigger for further medical investigations for decades.
Meanwhile, 28% had seizures with 22% showing a bulging fontanelle.
Of the 263 babies, 23 died and 56 of the surviving babies suffered serious complications.
The authors concluded that classic features of meningitis were "uncommon" among the babies studied.
Professor Paul Heath, one of the study investigators, said: "The symptoms displayed by young infants when they are seen by doctors at first in hospital are often non-specific and only half of cases showed signs of a fever.
"Clinicians must, therefore, still consider bacterial meningitis in the diagnosis of an unwell infant that doesn't present with fever."
Vinny Smith, chief executive at the MRF, said: "Young babies are particularly vulnerable to bacterial meningitis. Meningitis and septicaemia are deadly diseases that strike without warning. Rapid diagnosis and treatment provides the best chance of survival.
"Based on this research, we have collaborated with the study investigators to create a teaching package aimed at doctors and health professionals to aid rapid diagnosis and treatment.
"We have also updated our symptoms information for parents so that they know not to rely on fever alone as the main symptom to look out for in babies."
:: For more information visit: www.meningitis.org/HCPresources.