Emergency Department Clinical Pathway for
Evaluation/Treatment of Febrile Infants ≤ 56 Days Old
- 0 to 56 days of age
- Rectal temp ≥ 38.0 °C (100.4 °F) in past 24 hrs
- Well-appearing
- Consider Additional Evaluation/Treatment if:
- Premature birth < 37 weeks gestation
- Prolonged NICU stay
- Complex Medical History
- Physical Exam with Concern for Focal Bacterial Infection
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 |
Enhanced UA | ≥ 10 WBC/HPF or Positive gram stain |
CSF | 0-28 days: ≥ 15 WBC/µL 29-56 days: ≥ 9 WBC/µL |
- FLOC/RN Assessment and Bedside Procedure
- History and Physical
- IV and Laboratory Studies
- Bedside glucose as needed
- Consider HSV and Other Diagnostic Testing
- If 0-21 days old: LMX to LP site, LP tray at bedside
- 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
- CBC, blood culture
- No procalcitonin or CRP
- Enhanced UA, urine culture
- HSV testing
- Perform LP
- CBC, blood culture
- Inflammatory Markers (IMs): Procalcitonin, CRP, ANC
- Enhanced UA, urine culture
- Consider HSV testing
- Abnormal enhanced UA
- or
- ≥1 abnormal IM
- Perform LP
- Normal enhanced UA
- Normal IMs
- No LP
Infants 22-28 Days Old
Infants 29-56 Days Old
- CBC, blood culture
- Inflammatory Markers (IMs): Procalcitonin, CRP, ANC
- Enhanced UA, urine culture
- Consider HSV testing
- Normal enhanced UA
- ≥1 abnormal IM
- Perform LP
- Abnormal enhanced UA
- Normal IMs
- No LP
- Abnormal enhanced UA
- Abnormal IMs
- Consider LP
- Normal enhanced UA
- Normal IMs
- No LP
- Antimicrobials
- Acyclovir
- Admit
- Antimicrobials
- Admit
- No antimicrobials
- Admit for observation
- Antimicrobials
- Admit
- Antimicrobials
- Admit
- Discharge home with follow-up
or - Admit as indicated for bronchiolitis, no antimicrobials
Posted: August 2010
Revised: March 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
Revised: March 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
Evidence
- Evaluation and Management of Well-Appearing Febrile Infants 8 to 60 Days Old
- Concomitant Bacterial Meningitis in Infants With Urinary Tract Infection
- Lumbar Puncture for All Febrile Infants 29-56 Days Old: A Retrospective Cohort Reassessment Study
- Unpredictability of Serious Bacterial Illness in Febrile Infants From Birth to 1 Month of Age
- Performance of Low-risk Criteria in the Evaluation of Young Infants with Fever: Review of the Literature
- Costs and Infant Outcomes After Implementation of a Care Process Model for Febrile Infants
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