Evaluation and management of the febrile young infant (7 to 90 days of age)
- Hannah F Smitherman, MD
Hannah F Smitherman, MD
- Attending Physician
- Cook Children's Physician Network
- Charles G Macias, MD, MPH
Charles G Macias, MD, MPH
- Associate Professor of Pediatrics
- Baylor College of Medicine
- Section Editors
- Stephen J Teach, MD, MPH
Stephen J Teach, MD, MPH
- Section Editor — Pediatric Signs and Symptoms
- Professor of Pediatrics and Emergency Medicine
- George Washington University School of Medicine and Health Sciences
- Sheldon L Kaplan, MD
Sheldon L Kaplan, MD
- Editor-in-Chief — Pediatrics
- Section Editor — Pediatric Infectious Diseases
- Professor and Vice Chairman for Clinical Affairs
- Baylor College of Medicine
- Deputy Editor
- James F Wiley, II, MD, MPH
James F Wiley, II, MD, MPH
- Senior Deputy Editor — Adult and Pediatric Emergency Medicine
- Senior Deputy Editor — Primary Care Sports Medicine (Adolescents and Adults)
- Professor of Pediatrics and Emergency Medicine/Traumatology
- University of Connecticut School of Medicine
The evaluation of febrile young infants 7 to 90 days of age is discussed below. The definition and etiology of fever in this age group, as well as traditional strategies for evaluating febrile young infants, are discussed separately. (See "Febrile infants (7 to 90 days of age): Definition and etiology of fever" and "Strategies for the evaluation of febrile young infants (7 to 90 days of age)".)
The diagnosis, evaluation, and initial management of early-onset sepsis in neonates (younger than 7 days of age) is also discussed separately. (See "Clinical features, evaluation, and diagnosis of sepsis in term and late preterm infants", section on 'Evaluation and initial management'.)
In addition, the diagnosis and treatment of specific infections, including meningitis, pneumonia, and urinary tract infections and the evaluation of infants and children 3 to 36 months of age are discussed elsewhere. (See "Bacterial meningitis in children older than one month: Clinical features and diagnosis" and "Community-acquired pneumonia in children: Clinical features and diagnosis" and "Urinary tract infections in neonates" and "Fever without a source in children 3 to 36 months of age".)
Although most febrile young infants (7 to 90 days of age) have a benign viral illness, the goal of the evaluation is to identify those children who are at high risk for serious bacterial illness (eg, bacteremia, urinary tract infection, meningitis, bacterial gastroenteritis, or pneumonia), and who therefore require empiric antimicrobial therapy and possibly hospitalization.
The young febrile infant may demonstrate few, if any, interpretable clues to the underlying illness . The limitations of the history and physical examination in young infants with fever traditionally have led to an aggressive laboratory evaluation, even for patients who were previously healthy, are well-appearing, and have no focal infection. In the past, most of these patients have been admitted to the hospital for antibiotic treatment pending negative cultures. This practice is expensive and can result in iatrogenic morbidity for a substantial number of infants . Subsequently, criteria have been developed that can identify young infants with fever who are at low risk for serious bacterial illness and can be safely managed as outpatients (algorithm 1). (See "Strategies for the evaluation of febrile young infants (7 to 90 days of age)", section on 'Traditional strategies'.)
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- PHYSICAL EXAMINATION
- ANCILLARY STUDIES
- WBC count
- Blood culture
- Inflammatory mediators
- Molecular assays
- Urine examination
- Stool examination
- Cerebrospinal fluid studies
- Chest radiograph
- EVALUATION AND MANAGEMENT
- Neonates (7 to 28 days)
- - Antibiotic therapy
- - Acyclovir
- Ill-appearing infants (29 to 90 days)
- Well-appearing infants
- - 29 to 60 days
- - 61 to 90 days
- Follow up for outpatient treatment
- Discharge criteria for admitted patients
- DIFFICULT CLINICAL SITUATIONS
- Dry or traumatic lumbar puncture
- Patient on antibiotics
- Concomitant viral infections
- - Influenza
- - Bronchiolitis
- Otitis media
- INFORMATION FOR PATIENTS
- SUMMARY AND RECOMMENDATIONS
- Neonates (0 to 28 days)
- Ill-appearing infants (29 to 90 days)
- - Infants 29 to 60 days of age
- - Infants 61 to 90 days of age