PECARN Rule for Low Risk Febrile Infants 8-60 Days Old
Predicts risk of urinary tract infection, bacteremia, or bacterial meningitis in febrile infants age 8-60 days old.
Does not apply to ill-appearing infants.
The rule is intended to be one-directional; it may help rule out serious bacterial infection (SBI) in patients who are “low risk”, but the converse is not true (i.e., patients who are “not low risk” by the rule do not necessarily have SBI).
Some well-appearing infants aged 29-60 days who are at low risk for SBI may be suitable for discharge from the ED, with follow-up with their primary pediatrician or in the same ED in 24 hours for reassessment.
Infants aged 8-28 days who are deemed low risk for SBI should still be considered for admission for observation, though lumbar puncture and antibiotics may not be necessary.
High risk infants of any age should be considered for admission for close monitoring and empiric IV antibiotics.
- The decision to admit a febrile infant is multifactorial. Lack of reliable follow up may necessitate admission.
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For well-appearing immunocompetent infants and children aged 2 months to 2 years presenting with fever and no obvious infectious source, ACEP recommends the following:
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Consider chest X-ray if cough, hypoxia, rales, high fever (≥39°C), fever duration greater than 48 hours, or tachycardia/tachypnea out of proportion to fever (level B recommendation).
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Should not order chest X-ray if wheezing and high likelihood of bronchiolitis (level C recommendation).
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If dipstick urinalysis is negative and UTI is still suspected, obtain urine culture (level C recommendation).
Remember to consider a critical congenital heart defect (and empiric prostaglandin treatment) in the neonate presenting in shock.