FEBRILE INFANT ALGORITHM
Age:
0 – 28 days + Temp > 38º C
29 days – 3 mo. + Temp > 38º C
3 mo. – 3 years + Temp > 38º C – Non-toxic
3 mo. – 3 years + Temp > 38º C - Toxic
Full septic workup and hospitalization. Consider parenteral antibiotics.
Consider Rochester low risk criteria:
· Healthy, full term infant
· no previous antibiotic use
· no focus of infection on exam
· WBC 5,000 – 15,000
· urine unspun < 10 WBC’s per HPF
· if diarrhoea, < 5 fecal leucocytes per HPF
Allow home with close followup
Some would do LP first
Single IM dose of Ceftriaxone
Followup in 24-48 hr or sooner if change in status
Full septic workup and hospitalization.
Consider parenteral antibiotics.
Temperature 39º C or more
Temp 38º C - 39º C
No diagnostic tests or antibiotics
Acetaminophen 15 mg/kg q4h prn
Review if fever > 48 hr or if clinical condition deteriorates.
3 Months to 3 Years – Temp >39º
C or Toxic
Urinalysis and culture
· All females < 24 months
· All uncircumcised males < 12 months
· All circumcised males < 6 months
Management can vary depending on vaccine status.
Some sources still proceed with path 2 regardless of
vaccine status.
Urinalysis and culture only. No routine blood work
Acetaminophen
Careful followup in 24-48 hr or sooner if clinical status changes.
CBC
Blood culture (some sources do only if WBC>15000)
CXR if WBC > 20,000
Antibiotic if WBC > 15,000
Followup in 24-48 hours