Emergency Department and Inpatient Clinical Pathway
for Evaluation/Treatment of Febrile Infants ≤ 56 Days Old
with Community Onset Fever

Inclusion Criteria
  • 0 to 56 days of age
  • Recorded temp ≥ 38.0° C (100.4° F) in past 24 hrs
  • Well-appearing
Lab Study Definition of Abnormal
Procalcitonin > 0.5 ng/mL
Absolute Neutrophil Count > 4000 neutrophils/µL
< 1000 neutrophils/µL
Urinalysis with Reflex
to Microscopy
Any leukocyte esterase (LE) on dipstick
or
> 5 WBCs per hpf
CSF 0-28 days: ≥ 15 WBC/µL
29-56 days: ≥ 9 WBC/µL
Triage (Critical/Acute)
ED nursing pathway standing
order set: Febrile Young Infant
Summary of Pathway Updates
Adapted from AAP Guidelines 2021
Infants 0-21 Days Old
  • Blood culture
  • UA, urine culture
  • HSV Testing
  • Perform LP
  • Abnormal UA
    • or
  • ≥ 1 abnormal IM
  • Perform LP
  • Normal UA
  • Normal IMs
  • No LP
Infants 22-28 Days Old
Infants 29-56 Days Old
  • Normal UA
  • ≥ 1 abnormal IM
  • Perform LP
  • Abnormal UA
  • Normal IMs
  • No LP
  • Abnormal UA
  • Abnormal IMs
  • LP Guidance
  • Normal UA
  • Normal IMs
  • No LP
Antimicrobials
Acyclovir
  • No antimicrobials
  • Discharge home w/follow-up
  • or
  • Admit w/o antimicrobials as indicated for etiologies other than serious bacterial infections
Admit from Emergency Department