ED Pathway for Evaluation/Treatment of Febrile Young Infants (0-56 Days Old)
  • Low Risk for Bacterial Meningitis:
    29-56 days old
    Full-term (≥37 weeks gestation)
    No prolonged NICU stay
    No chronic medical problems
    No systemic antibiotics within 72 hours
    Well-appearing and easily consolable
    No infections on exam
  • Blood:
    WBC ≥ 5,000 and ≤ 15,000
    Band to neutrophil ratio < 0.2
    (Bands/bands + neutrophils)
  • Enhanced UA:
    WBC < 10 /HPF
    Negative Gram stain
  • Chest x-ray (if obtained):
    No infiltrate
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MD/CRNP/RN Assessment
and Bedside Procedure

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All Infants 0-28 Days
All Ill Infants 0-56 Days
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Perform LP
Antimicrobials
Admit
Infant 29 to 56 Days
with or without Bronchiolitis
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Review Low Risk Criteria, including CBC and enhanced UA (without CSF)
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*HIGH RISK
  • Perform LP
  • Antimicrobials
  • Admit
Needs Admission
for Bronchiolitis
  • No antimicrobials
  • Admit
LOW RISK
  • No antimicrobials
  • Discharge
  • Assure NP follow-up call
*If data is incomplete (e.g. urine or blood could not be obtained), consider patient High Risk

Antimicrobial Therapy:
(Meningitic doses are used initially-see ED Febrile Infant Order Set)

0-21 daysAmpicillin/Cefotaxime/Acyclovir
22-28 daysAmpicillin/Cefotaxime
29-56 daysCefotaxime
 
Additional Considerations:
Add VancomycinIll Patient
CSF WBC > 8 w/abnormal glucose or protein
Gram positive organism on Gram stain
  
Call IDGram negative organism on Gram stain
Imipenem and Amikacin
  
HSV
Testing/

Treatment

Start Acyclovir for ALL infants ≤ 21 days and for infants 22 to 40 days with ≥ 1 of the following:
Ill Appearing
Abnormal neurologic status, seizures
Vesicular rash
Hepatitis
Mom known to have primary HSV infection at delivery

Posted: August 2010
Revised: September 2011, April 2014, October 2014
Authors: R. Scarfone MD; R. Gala MD; A. Murray MD; MK Funari RN; J. Lavelle MD; L. Bell MD
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