The Step-by-Step approach to Fever in Infants

Pediatrics

The Step-by-Step Approach for Determining Risk in Infants with Fever of Unknown Etiology

Validated for use infants 90 days or younger.

Infants are considered at a low risk for invasive bacterial infection when they meet NONE of the following criteria.

CRITERIA SETTING

Ill-appearing i.e. abnormal ABC ( Appearance, Breathing, Circulation to the skin) assessment.

Initial examination by the physician

Age ≤ 21 days

Initial history by the physician

Dipstick urinalysis positive for leukocyte esterase

Point-of-care test

Procalcitonin ≥ 0.5 ng per mL

Laboratory test

C-reactive protein > 20 mg per L (190.5 nmol per L) or absolute neutrophil count > 10,000 per mm3 (10 × 109 per L)

Laboratory test

Treating Low-risk infants

“A missed invasive bacterial infection does not necessarily lead to a bad outcome. Appropriate management options for infants classified as low risk might include admission for a period of observation; blood and urine cultures; a broad-spectrum antibiotic, such as ceftriaxone; or discharge home when prompt follow-up is guaranteed. Management depends on many factors, including the infant and family, the hospital, the outpatient physician, and community standards. Strategies such as hospital observation or home discharge with follow-up exist to increase the likelihood that any missed infections are discovered and treated.” AAFP 2018

 

Further Reading / Reference
Am Fam Physician. 2018 Jan 1;97(1):45-46. Young Febrile Infants: Step-by-Step Evaluation.

http://pediatrics.aappublications.org/content/pediatrics/early/2016/07/01/peds.2015-4381.full.pdf, Last Accessed 4/2/2018

Arch Dis Child. 2010 Dec;95(12):968-73. Validation of a laboratory risk index score for the identification of severe bacterial infection in children with fever without source.

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