Inpatient Pathway for Treatment of the Febrile Young Infant
Philadelphia Criteria (29-56d)
  • Well-appearing
  • CBC
  • WBC ≥ 5 k and ≤ 15 k
  • Band to neutrophil ratio < 0.2
  • (Bands / Bands + neutrophils)
  • Enhanced UA
  • WBC < 10/HPF
  • Negative Gram stain
  • CSF
  • WBC < 8/HPF
  • Normal glucose, protein
  • Negative Gram stain
  • If Obtained
  • CXR clear
Review ED Care
Perform H & P
MD/CRNP/RN Bedside Care
Use General Pediatrics Febrile Young Infant Inpatient Order Set

Blood, Urine, CSF Cultures NEGATIVE

CSF Profile NORMAL, Gram Stain NEGATIVE

Enhanced UA NORMAL

HSV, CSF, Blood, PCR NEGATIVE, if sent

OR
Enterovirus Meningitis
Manage as per the Bronchiolitis Pathway
AND
consider evaluation for bacterial infection if new fever develops

Interpretable LP

Discharge 24 hours from time of last culture if child looks well

Uninterpretable LP/Bloody Tap

Discharge 36 hours from time of last culture if child looks well

Antimicrobial Therapy:

(Meningitic doses are used initially-see ED Febrile Infant Order Set)

0-21 days Ampicillin/Cefotaxime/Acyclovir
22-28 days Ampicillin/Cefotaxime
29-56 days Ceftriaxone

Additional Considerations:

Add Vancomycin
  • Ill Patient
  • CSF WBC > 8 w/abnormal glucose or protein
  • Gram positive organism on Gram stain
Call ID
  • Gram negative organism on Gram stain
  • Meropenem and Amikacin
HSV
Testing / Treatment
  • Start Acyclovir for infants ≤ 21 days or for infants 22 to 40 days with ≥ 1 of the following:
  • Ill Appearing
  • Abnormal neurologic status, seizures
  • Vesicular rash
  • Hepatitis
Posted: May 2011
Revised: October 2013, February 2014, August 2016, October 2017, September 2018, October 2018
Authors: L. Bell, MD; E. Kane MD, MS; J. Lavelle, MD; A. Simon, CRNP