Emergency Department and Inpatient Clinical Pathway for Evaluation/Treatment of Febrile Infants ≤ 56 Days Old with Community Onset Fever
- Related Pathways
- Summary of Pathway Updates
- Adapted from AAP Guidelines 2021
Inclusion Criteria
- 0–56 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 |
| Urinalysis with Reflex to Microscopy |
|
| CSF |
|
ED nursing pathway standing order set: Febrile Young Infant
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 N/IICU Pathway
- Sepsis ED, Inpatient, PICU Pathway
0–21 Days Old
- Blood culture
- UA, urine culture
- HSV testing
- Perform LP
22–28 Days Old
- CBC, blood culture
- Inflammatory markers (IMs): procalcitonin, ANC
- UA, urine culture
- Consider HSV and other diagnostic testing
29–56 Days Old
- CBC, blood culture
- Inflammatory markers (IMs): procalcitonin, ANC
- UA, urine culture
- Consider HSV and other diagnostic testing
- Abnormal UA
- or
- ≥ 1 abnormal IM
- Perform LP
- Normal UA
- Normal IMs
- No LP
- Normal UA
- ≥ 1 abnormal IM
- Perform LP
- Abnormal UA
- Abnormal IMs
- LP Guidance
- Abnormal UA
- Normal IMs
- No LP
- Normal UA
- Normal IMs
- No LP
No antimicrobials
- Discharge home with follow-up
- or
- Admit without 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
Education Module and Podcast