Infectious Disease Book


Milwaukee Criteria for Febrile Infant 28-56 days

Aka: Milwaukee Criteria for Febrile Infant 28-56 days, Milwaukee Criteria for Febrile Infant, Milwaukee Criteria for Infant with Fever, Febrile Infant Evaluation with Milwaukee Criteria
  1. See Also
    1. Fever Without Focus
    2. Fever Without Focus Management Birth to 3 Months
    3. Fever Without Focus Management 3 to 36 months
    4. Philadelphia Criteria for Febrile Infant 29-60 days
    5. Rochester Criteria for Febrile Infant 0 to 60 days
    6. Boston Criteria for Febrile Infant 28-89 days
    7. Yale Scale for Febrile Child 3 to 36 months
    8. Pediatric Sepsis
    9. Neonatal Sepsis
    10. Fever Without Focus Red Flags
  2. Indications
    1. Assessment of febrile infant (>38.0 C or 100.4 F) aged 28-56 days
    2. Reassures against serious infection (Occult Bacteremia)
  3. Criteria: Reassuring if all criteria are present
    1. Well appearing infant
      1. Alert and active
      2. Normal respiratory status
      3. Normal Muscle tone
    2. Reassuring examination
      1. Not dehydrated
      2. No signs of focal infection
        1. No Otitis Media
        2. No soft tissue infection
        3. No bone or joint infection
    3. Labs
      1. White blood count (WBC) <15,000/mm3
      2. Urinalysis <5-10 WBC/hpf
      3. Urine Gram Stain Negative for Bacteria
      4. Urine Leukocyte Esterase and nitrite negative
      5. CSF <10 WBC/mm3
      6. Chest XRay no infiltrate (if obtained)
  4. Interpretation
    1. Higher risk
      1. Management per local protocol for possible Occult Bacteremia
    2. Lower risk (all reassuring criteria met)
      1. Supports discharge with antibiotics (Ceftriaxone 50 mg/kg IM)
      2. Close interval follow-up within 24 hours
  5. Efficacy
    1. Test Sensitivity: 96%
    2. Test Specificity: 42%
    3. Negative Predictive Value: 99%
  6. References
    1. Herman (2015) Crit Dec Emerg Med 29(12):14-19
    2. Hui (2012) Evid Rep Technol Assess (205):1-297 +PMID:24422856 [PubMed]

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