Strategies for the evaluation of febrile young infants (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
- Gary R Fleisher, MD
Gary R Fleisher, MD
- Editor-in-Chief — Adult and Pediatric Emergency Medicine
- Section Editor — Pediatric Signs and Symptoms
- Egan Family Foundation Professor
- Harvard Medical School
- Morven S Edwards, MD
Morven S Edwards, MD
- Section Editor — Pediatric Infectious Diseases
- Professor of Pediatrics
- 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
Several strategies for identifying the infant with fever who has an invasive bacterial illness have been proposed and tested. The strengths and limitations of these protocols, as well as the utilization of proposed guidelines are discussed here.
The definition and etiology of fever in infants 7 to 90 days of age, as well as the evaluation and management of fever in these patients, are discussed elsewhere. (See "Febrile infants (7 to 90 days of age): Definition and etiology of fever" and "Evaluation and management of the febrile young infant (7 to 90 days of age)".)
Fever is a prominent symptom of many different disease processes. Neonates and young infants may manifest fever as the only sign of significant underlying infection. Clinically distinguishing those with a serious febrile illness from those who are mildly ill may be difficult . This has led to an aggressive approach to fever in this age group, usually including diagnostic tests, empiric antibiotics and, often, hospital admission.
A systematic approach to evaluating infants with fever without a source in this age group would ideally identify the patient with a serious bacterial illness (SBI) and minimize the testing and treatment of the patient with a mild illness.
Several studies have attempted to identify patients who can be managed safely as outpatients with or without empiric antibiotic treatment . There is some variation among them regarding inclusion criteria, inpatient or outpatient population, and whether or not antibiotics were given expectantly. This has led to confusion in the literature and a lack of consensus regarding the optimal approach to young infants with fever. Furthermore, even when guidelines have been proposed, they have not been consistently followed by many practitioners in the community [3-5]. (See 'Problems with these approaches' below.)
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- TRADITIONAL STRATEGIES
- Boston protocol
- Philadelphia protocol
- Rochester protocol
- Limitations in neonates
- CLINICAL GUIDELINES
- Expert panel
- American College of Emergency Physicians
- PROBLEMS WITH THESE APPROACHES
- Limitations of protocols
- Utilization of guidelines
- INFORMATION FOR PATIENTS