Infectious Disease Book

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Step-By-Step Protocol for Febrile Infants

Aka: Step-By-Step Protocol for Febrile Infants, Step By Step Fever Evaluation in Age Under 90 Days
  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. Laboratory Score for Febrile Infants
    9. Rochester Criteria for Febrile Infant 0 to 60 days
    10. Philadelphia Criteria for Febrile Infant 29-60 days
    11. Milwaukee Criteria for Febrile Infant 28-56 days
    12. Boston Criteria for Febrile Infant 28-89 days
  2. Indications
    1. Risk Stratification of Febrile Infants under age 90 days
  3. Precautions
    1. Study focused on infants >21 days, but may be safer to apply to >28 day old infants
    2. Assumes well appearing infant
      1. See Pediatric Assessment Triangle
  4. Protocol
    1. Step 0: Ill or toxic appearing infant
      1. Evaluate and Manage as high risk (see Neonatal Sepsis)
    2. Step 1: Obtain Urinalysis
      1. Positive Urinalysis for Leukocytes: Treat as intermediate risk (complete Neonatal Sepsis workup)
    3. Step 2: Obtain Procalcitonin, CBC, CRP (if Urinalysis negative)
      1. Negative markers: Treat as low risk with close interval follow-up
      2. Positive markers: Treat as intermediate risk (complete Neonatal Sepsis workup)
        1. Procalcitonin >0.5 ng/ml OR
        2. CRP >20 OR
        3. Absolute Neutrophil Count >10,000
  5. References
    1. Claudius and Behar in Herbert (2016) EM:Rap 16(12): 1-2
    2. Gomez (2016) Pediatrics 138(2): e20154381 +PMID: 27382134 [PubMed]
    3. Martinez (2015) Pediatr Infect Dis J 34(5): 494-8 +PMID: 25461476 [PubMed]
    4. Steinberg (2018) Am Fam Physician 97(1):45-6 [PubMed]

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