Emergency Department Clinical Pathway for
Evaluation/Treatment of Febrile Infants ≤ 56 Days Old

Goals and Metrics
Provider Resources
Related Pathway
Febrile Young Infant ≤ 56 Days Old
  • 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
Antimicrobials: Recommendations, Dosing, and Rationale
Triage (Critical/Acute)
ED Nursing Pathway Standing Order Set:
Febrile Young Infant
  • As clinically
    indicated:
    • Sepsis Huddle
    • Sepsis Pathway
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
  • No antimicrobials
  • Admit for observation
  • Discharge home with follow-up
  • or
  • Admit as indicated for bronchiolitis, no antimicrobials
Posted: August 2010
Revised: September 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