Febrile Infant Clinical Pathway — Emergency Department and Inpatient
Febrile Infant Clinical Pathway — Emergency Department and Inpatient
Discharge Criteria for Infants with Negative Cultures
- Well-appearing, feeding well
- Blood, urine, and CSF cultures (if obtained) negative
- HSV studies negative if sent
- Discharge at 24 hours if CSF WBC count (if obtained) is interpretable, 36 hours if uninterpretable
- Correction factors for CSF contaminated with RBCs have not been validated in large-scale studies and should be used with caution. Absence of neutrophils makes bacterial meningitis less likely but should be considered within the clinical context when determining risk of bacterial meningitis.
- Notify PCP, ensure close follow-up within 72 hours
Considerations for 22-28 Days Old, Low Risk
For this age group who are low risk by history and lab values, the pathway recommends admission and observation. If patient at any time becomes ill-appearing, or the blood culture becomes positive, they should undergo LP and start antimicrobials. If UA is negative but urine culture only becomes positive, can consider deferring LP and starting empiric antibiotics if well-appearing.
Of note, inflammatory markers can be negative early in illness. Therefore, for low risk infants 22-28 days, consider repeat IM’s if patient remains febrile and initially presented less than 6 hours from first fever. If IM positive, consider performing LP and starting antimicrobials.