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
-
The following infants may have higher risk of invasive bacterial infection. IMs alone should not be used for risk stratification:
- Premature birth < 37 wks gestation
- Prolonged N/IICU stay
- Complex Medical History
- Physical Exam with Concern for Focal Bacterial Infection
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 |
- ED Team Assessment and
Bedside Procedure - History and Physical
- IV and Laboratory Studies
- POC glucose as needed
-
Consider HSV and Other
Diagnostic Testing - If 0-21 days old: LMX to LP site,
LP tray at bedside
-
Ill-appearing or as clinically indicated:
- Sepsis Huddle
- Sepsis Pathway
Summary of Pathway Updates
Adapted from AAP Guidelines 2021
Adapted from AAP Guidelines 2021
Infants 0-21 Days Old
- Blood culture
- UA, urine culture
- HSV Testing
- Perform LP
- CBC, blood culture
- Inflammatory Markers (IMs): Procalcitonin, ANC
- UA, urine culture
- Consider HSV Testing
-
Abnormal UA
- or
- ≥ 1 abnormal IM
- Perform LP
- Normal UA
- Normal IMs
- No LP
Infants 22-28 Days Old
Infants 29-56 Days Old
- CBC, blood culture
- Inflammatory Markers (IMs): Procalcitonin, ANC
- UA, urine culture
- Consider HSV Testing
- 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
- 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
Evidence
- Evaluation and Management of Well-Appearing Febrile Infants 8 to 60 Days Old
- Use of Procalcitonin Assays to Predict Serious Bacterial Infection in Young Febrile Infants
- Time to Pathogen Detection for Non-ill Versus Ill-Appearing Infants ≤60 Days Old With Bacteremia and Meningitis
- Prevalence of Bacterial Meningitis Among Febrile Infants Aged 29-60 Days With Positive Urinalysis Results: A Systematic Review and Meta-analysis
- Validation of the “Step-by-Step” Approach in the Management of Young Febrile Infants
- View All Evidence