Infectious Disease Book

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Laboratory Score for Febrile Infants

Aka: Laboratory Score for Febrile Infants, Laboratory Score for Febrile Infants Age 1 to 3 months, C-Reactive Protein Evaluation for Febrile Infants Age 1 to 3 months, CRP Evaluation for Febrile Infants Age 1 to 3 months, Procalcitonin Evaluation for Febrile Infants Age 1 to 3 months
  1. See Also
    1. Fever Without Focus
    2. Fever Without Focus Management Birth to 3 Months
    3. Step-By-Step Protocol for Febrile Infants
    4. Toxic Findings Suggestive of Occult Bacteremia
    5. Fever Without Focus Labs
    6. Pediatric Sepsis
    7. Neonatal Sepsis
    8. Rochester Criteria for Febrile Infant 0 to 60 days
    9. Philadelphia Criteria for Febrile Infant 29-60 days
    10. Milwaukee Criteria for Febrile Infant 28-56 days
    11. Boston Criteria for Febrile Infant 28-89 days
  2. Indications
    1. Evaluation of Febrile Infants Age 1 to 3 months
    2. Inflammatory markers with greater Positive Predictive Value of serious infection than White Blood Cell Count
  3. Labs: C-Reactive Protein (CRP)
    1. CRP <10 mg/L has a Negative Predictive Value for Sepsis of 99%
    2. CRP >40 mg/L is more suggestive of serious Bacterial illness (but not sensitive or specific)
    3. Single CRP is inadequate for reassurance (repeat in 24 hours)
    4. NSAIDs modify CRP significantly (Ibuprofen increases, Naproxen decreases)
    5. Bilavsky (2009) Acta Paediatr 98(11): 1776-80 +PMID:19664100 [PubMed]
    6. McWilliam (2010) Arch Dis Child Educ Pract Ed 95(2): 55-8 +PMID:20351152 [PubMed]
  4. Labs: Procalcitonin (PCT)
    1. Procalcitonin rapidly increases above normal threshold with fever onset in serious Bacterial Infection
    2. PCT <0.5 ng/ml has a Negative Predictive Value for serious Bacterial Infection of 90%
    3. PCT >0.6 (and WBC >19k, blasts >1.8k, Neutrophils >13k) suggests serious Bacterial Infection
    4. Olaciregui (2009) Arch Dis Child 94(7): 501-5 +PMID:19158133 [PubMed]
    5. Mahajan (2014) Acad Emerg Med 21(2): 171-9 +PMID:24673673 [PubMed]
  5. Labs: Laboratory Score
    1. Criteria
      1. Procalcitonin (PCT)
        1. Score 0: Procalcitonin <0.5 ng/ml
        2. Score 2: Procalcitonin 0.5 to 1.9 ng/ml
        3. Score 4: Procalcitonin >= 2.0 ng/ml
      2. C-Reactive Protein (C-RP)
        1. Score 0: C-Reactive Protein <40 mg/ml
        2. Score 2: C-Reactive Protein 40 to 99 mg/ml
        3. Score 4: C-Reactive Protein >=100 mg/ml
      3. Urinalysis dipstick
        1. Score 0: Negative
        2. Score 1: Urine Dipstick with Leukocyte esterase or nitrite positive
    2. Interpretation
      1. Score >3 points suggests higher risk for serious Bacterial Infection
    3. References
      1. Lacour (2008) Pediatr Infect Dis J 27(7): 654-6 [PubMed]
  6. References
    1. Freyne (2013) Clin Pediatr 52(6): 503-6 +PMID:23613177 [PubMed]
    2. Stein (2015) Clin Pediatr 54(5): 439-44 +PMID:25294884 [PubMed]

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