Inpatient Pathway for Treatment of the Febrile Young Infant
Philadelphia Criteria (29-56d)

Well-appearing

CBC:

  • WBC ≥ 5 k and ≤ 15 k
  • Band to neutrophil ratio < 0.2
  • (Bands / Bands + neutrophils)

Enhanced UA:

  • WBC < 10/HPF
  • Negative Gram stain

CSF:

  • WBC < 8/HPF
  • Normal glucose, protein
  • Negative Gram stain

If Obtained:

  • CXR clear
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Review ED Care
Perform H & P
MD/CRNP/RN Bedside Care
Use General Pediatrics Febrile Young Infant Inpatient Order Set
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Manage as per the Bronchiolitis Pathway
AND
consider evaluation for bacterial infection if new fever develops

Blood, Urine, CSF Cultures NEGATIVE

CSF Profile NORMAL, Gram Stain NEGATIVE

Enhanced UA NORMAL

HSV, CSF, Blood, PCR NEGATIVE, if sent

Enterovirus Meningitis
OR
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Interpretable LP

Discharge 24 hours from time of last culture if child looks well

Uninterpretable LP/Bloody Tap

Discharge 36 hours from time of last culture if child looks well

Antimicrobial Therapy:

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

0-21 days Ampicillin/Cefotaxime/Acyclovir
22-28 days Ampicillin/Cefotaxime
29-56 days Cefotaxime

Additional Considerations:

Add Vancomycin Ill Patient
CSF WBC > 8 w/abnormal glucose or
protein
Gram positive organism on Gram stain
Call ID Gram negative organism on Gram stain
Imipenem and Amikacin
HSV
Testing / Treatment
Start Acyclovir for infants ≤ 21 days or
for infants 22 to 40 days with ≥ 1 of the following:
Ill Appearing
Abnormal neurologic status, seizures
Vesicular rash
Hepatitis
Posted: May 2011
Revised: October 2013, February 2014
Authors: Lou Bell, MD; Jane Lavelle, MD; Anna M. Simon, CRNP