Febrile Infants Aged ≤60 Days: Evaluation and Management in the Emergency Department (Pharmacology CME and Infectious Disease CME)

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Delivery Method:	Online
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Publication Date: February 2024 (Volume 21, Number 2)

CME Credits: 4 AMA PRA Category 1 Credits™, 4 ACEP Category I Credits, 4 AAP Prescribed Credits, 4 AOA Category 2-B Credits. CME expires 02/01/2027.

Specialty CME Credits: Included as part of the 4 credits, this CME activity is eligible for 1 Pharmacology CME credit and 1 Infectious Disease CME credit, subject to your state and institutional approval.

Authors

Peer Reviewers

Abstract

Emergency clinicians frequently provide care to febrile infants aged ≤60 days in the emergency department. In these very young infants, fever may be the only presenting sign of invasive bacterial infection and, if untreated, invasive bacterial infection can lead to severe outcomes. This issue reviews newer risk-stratification tools and the 2021 American Academy of Pediatrics clinical practice guideline to provide recommendations for the evaluation and management of febrile young infants. The most recent literature assessing the risk of concomitant invasive bacterial infection with urinary tract infections or positive viral testing is also reviewed.

Case Presentations

A full-term, well-appearing 25-day-old boy presents to the ED for evaluation of fever...

• The patient felt warm to the parents today but has otherwise been asymptomatic.
• The physical examination is normal, except for a fever of 38˚C measured rectally in the ED.
• What is the differential diagnosis? How should you approach evaluation and treatment? Can this baby be discharged home?

A 40-day-old girl presents to the ED in January for evaluation of a rectal temperature of 100.4˚F (38˚C) measured at home...

• The history and physical examination are reassuring, except that she has nasal discharge and a cough.
• Which risk-stratification algorithm should you use for this infant? Would the workup change if a respiratory swab was positive for SARS-CoV-2?

A 50-day-old girl presents to the ED for evaluation of fever...

• The history and physical examination are unremarkable except for the presence of fever of 38˚C measured rectally in the ED. You send blood and urine tests, and the urinalysis results are positive for leukocyte esterase, with >20 white blood cells/high-power field.
• Does this infant require a lumbar puncture? Should the infant be admitted on IV antibiotics or can she receive oral antibiotics and be discharged home?

Accreditation:

EB Medicine is accredited by the Accreditation Council for Continuing Medical Education (ACCME) to provide continuing medical education for physicians.