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
  • Rectal temp ≥ 38.0° C (100.4° F) in past 24 hrs
  • Well-appearing
Lab Study Definition of Abnormal
Procalcitonin > 0.5 ng/mL
C-reactive Protein > 2 mg/dL
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
  • CBC, blood culture
  • No procalcitonin or CRP
  • 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
  • Consider LP
  • Normal UA
  • Normal IMs
  • No LP
Antimicrobials
Acyclovir
  • No antimicrobials
  • Discharge home with follow-up
  • or
  • Admit w/o antimicrobials as indicated for etiologies other than serious bacterial infections
Admit from Emergency Department
Posted: August 2010
Revised: November 2022
Authors: R. Scarfone, MD; P. Gala, MD; L. Sartori, MD; B. Ku, MD; J. Lavelle, MD; MK Abbadessa, ACCNS-P; L. Bell, MD; E. Kane, MD; E. Kahle, MD; C. Jacobstein, MD; K. Chiotos, MD; T. Metjian, PharmD