Febrile infant (younger than 90 days of age): Management
- 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
- Morven S Edwards, MD
Morven S Edwards, MD
- Section Editor — Pediatric Infectious Diseases
- Professor of Pediatrics
- Baylor College of Medicine
- 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
- Deputy Editor
- James F Wiley, II, MD, MPH
James F Wiley, II, MD, MPH
- Senior Deputy Editor — UpToDate
- Deputy Editor — Adult and Pediatric Emergency Medicine
- Deputy Editor — Primary Care Sports Medicine (Adolescents and Adults)
- Clinical Professor of Pediatrics and Emergency Medicine/Traumatology
- University of Connecticut School of Medicine
The management of febrile infants younger than 90 days of age is discussed in this topic.
For a discussion of the outpatient evaluation of febrile infants younger than 90 days of age; definition of fever in the young infant; the diagnosis, evaluation, and initial management of fever and early-onset sepsis in neonates (younger than 7 days of age); and the approach to an ill-appearing infant without fever refer to the following topics:
- Baker MD, Avner JR, Bell LM. Failure of infant observation scales in detecting serious illness in febrile, 4- to 8-week-old infants. Pediatrics 1990; 85:1040.
- Bonadio WA, Hennes H, Smith D, et al. Reliability of observation variables in distinguishing infectious outcome of febrile young infants. Pediatr Infect Dis J 1993; 12:111.
- Bachur RG, Harper MB. Predictive model for serious bacterial infections among infants younger than 3 months of age. Pediatrics 2001; 108:311.
- Gómez B, Mintegi S, Benito J, et al. Blood culture and bacteremia predictors in infants less than three months of age with fever without source. Pediatr Infect Dis J 2010; 29:43.
- Gomez B, Mintegi S, Bressan S, et al. Validation of the "Step-by-Step" Approach in the Management of Young Febrile Infants. Pediatrics 2016; 138.
- Turner D, Leibovitz E, Aran A, et al. Acute otitis media in infants younger than two months of age: microbiology, clinical presentation and therapeutic approach. Pediatr Infect Dis J 2002; 21:669.
- Jaskiewicz JA, McCarthy CA, Richardson AC, et al. Febrile infants at low risk for serious bacterial infection--an appraisal of the Rochester criteria and implications for management. Febrile Infant Collaborative Study Group. Pediatrics 1994; 94:390.
- Dagan R, Powell KR, Hall CB, Menegus MA. Identification of infants unlikely to have serious bacterial infection although hospitalized for suspected sepsis. J Pediatr 1985; 107:855.
- Nozicka CA, Hanly JG, Beste DJ, et al. Otitis media in infants aged 0-8 weeks: frequency of associated serious bacterial disease. Pediatr Emerg Care 1999; 15:252.
- Sommerfleck P, González Macchi ME, Pellegrini S, et al. Acute otitis media in infants younger than three months not vaccinated against Streptococcus pneumoniae. Int J Pediatr Otorhinolaryngol 2013; 77:976.
- Greenhow TL, Hung YY, Herz AM. Changing epidemiology of bacteremia in infants aged 1 week to 3 months. Pediatrics 2012; 129:e590.
- Kadish HA, Loveridge B, Tobey J, et al. Applying outpatient protocols in febrile infants 1-28 days of age: can the threshold be lowered? Clin Pediatr (Phila) 2000; 39:81.
- Ferrera PC, Bartfield JM, Snyder HS. Neonatal fever: utility of the Rochester criteria in determining low risk for serious bacterial infections. Am J Emerg Med 1997; 15:299.
- Baker MD, Bell LM. Unpredictability of serious bacterial illness in febrile infants from birth to 1 month of age. Arch Pediatr Adolesc Med 1999; 153:508.
- Chiu CH, Lin TY, Bullard MJ. Application of criteria identifying febrile outpatient neonates at low risk for bacterial infections. Pediatr Infect Dis J 1994; 13:946.
- Schwartz S, Raveh D, Toker O, et al. A week-by-week analysis of the low-risk criteria for serious bacterial infection in febrile neonates. Arch Dis Child 2009; 94:287.
- Hui C, Neto G, Tsertsvadze A, et al. Diagnosis and Management of Febrile Infants (0-3 months). Evidence Report/Technology Assessment No. 205 (Prepared by the University of Ottawa: Evidence-based Practice Center under Contract No. HHSA 290-2007-10059-I). AHRQ Publication No. 12-E004-EF. Rockville, MD: Agency for Healthcare Research and Quality. March 2012. Available at http://www.ahrq.gov/research/findings/evidence-based-reports/febrinftp.html (Accessed August 3, 2015)
- Schnadower D, Kuppermann N, Macias CG, et al. Febrile infants with urinary tract infections at very low risk for adverse events and bacteremia. Pediatrics 2010; 126:1074.
- Hernández-Bou S, Trenchs V, Alarcón M, Luaces C. Afebrile very young infants with urinary tract infection and the risk for bacteremia. Pediatr Infect Dis J 2014; 33:244.
- Hoberman A, Wald ER, Hickey RW, et al. Oral versus initial intravenous therapy for urinary tract infections in young febrile children. Pediatrics 1999; 104:79.
- Bachur R, Caputo GL. Bacteremia and meningitis among infants with urinary tract infections. Pediatr Emerg Care 1995; 11:280.
- Byington CL, Reynolds CC, Korgenski K, et al. Costs and infant outcomes after implementation of a care process model for febrile infants. Pediatrics 2012; 130:e16.
- Gomez B, Bressan S, Mintegi S, et al. Diagnostic value of procalcitonin in well-appearing young febrile infants. Pediatrics 2012; 130:815.
- Milcent K, Faesch S, Gras-Le Guen C, et al. Use of Procalcitonin Assays to Predict Serious Bacterial Infection in Young Febrile Infants. JAMA Pediatr 2016; 170:62.
- Chua KP, Neuman MI, McWilliams JM, et al. Association between Clinical Outcomes and Hospital Guidelines for Cerebrospinal Fluid Testing in Febrile Infants Aged 29-56 Days. J Pediatr 2015; 167:1340.
- Dayan PS, Hanson E, Bennett JE, et al. Clinical course of urinary tract infections in infants younger than 60 days of age. Pediatr Emerg Care 2004; 20:85.
- Hsiao AL, Chen L, Baker MD. Incidence and predictors of serious bacterial infections among 57- to 180-day-old infants. Pediatrics 2006; 117:1695.
- Hanson AL, Schunk JE, Corneli HM, Soprano JV. A Randomized Controlled Trial of Positioning for Lumbar Puncture in Young Infants. Pediatr Emerg Care 2016; 32:504.
- Nigrovic LE, Kuppermann N, Neuman MI. Risk factors for traumatic or unsuccessful lumbar punctures in children. Ann Emerg Med 2007; 49:762.
- McGowan KL, Foster JA, Coffin SE. Outpatient pediatric blood cultures: time to positivity. Pediatrics 2000; 106:251.
- Garcia-Prats JA, Cooper TR, Schneider VF, et al. Rapid detection of microorganisms in blood cultures of newborn infants utilizing an automated blood culture system. Pediatrics 2000; 105:523.
- Pantell RH. Febrile infants: aligning science, guidelines, and cost reduction with quality of individualized care. Pediatrics 2012; 130:e199.
- DEFINITION OF FEVER
- Herpes simplex virus infection
- Focal infection
- - Otitis media
- - Other focal bacterial infections
- - Neonates (28 days of age and younger)
- - Infants 29 to 60 days of age
- - Infants 61 to 90 days of age
- Patients with viral infections
- Special situations
- - Traumatic or dry lumbar puncture
- - Receiving antibiotics
- OUTPATIENT FOLLOW-UP
- DISCHARGE CRITERIA FOR ADMITTED PATIENTS
- CLINICAL PRACTICE GUIDELINES
- SOCIETY GUIDELINE LINKS
- SUMMARY AND RECOMMENDATIONS