Evaluation and Management of the Febrile Young Infant in the Emergency Department

Points and Pearls Excerpt

• Multiple studies have demonstrated that observation scales and clinician suspicion for severe bacterial infection (SBI) are poorly predictive of bacterial infection in febrile infants.
• Neonates have the highest prevalence of SBI and invasive bacterial infection. Febrile neonates should have a full sepsis workup and be hospitalized and treated with empiric antibiotic therapy.
• At a minimum, order urine studies for the febrile infant aged 57 to 89 days, with a strong consideration to blood testing as well, as these patients are still at risk for a urinary tract infection.

Most Important References

• * Gomez B, Mintegi S, Bressan S, et al. Validation of the “Step-by-Step” approach in the management of young febrile infants. Pediatrics. 2016;138(2). (Prospective; 2185 patients)
• * Kuppermann N, Dayan PS, Levine DA, et al. A clinical prediction rule to identify febrile infants 60 days and younger at low risk for serious bacterial infections. JAMA Pediatr. 2019;173(4):342-351. (Prospective; 1821 patients)
• * Biondi EA, Lee B, Ralston SL, et al. Prevalence of bacteremia and bacterial meningitis in febrile neonates and infants in the second month of life: a systematic review and meta-analysis. JAMA Netw Open. 2019;2(3):e190874. (Systematic review and meta-analysis)
• American College of Emergency Physicians Clinical Policies Subcommittee (Writing Committee) on Pediatric Fever, Mace SE, Gemme SR. Clinical policy for well-appearing infants and children younger than 2 years of age presenting to the emergency department with fever. Ann Emerg Med. 2016;67(5):625-639. (Policy statement)
• * Aronson PL, Wang ME, Shapiro ED, et al. Risk Stratification of Febrile Infants ≤60 Days Old Without Routine Lumbar Puncture. Pediatrics. (Case-control; 384 patients)