MDCalc

Step-by-Step Approach to Febrile Infants

Identifies febrile infants ≤90 days old at low risk of invasive bacterial infections.

Use in previously healthy infants ≤90 days old presenting with fever without a source.

Ill appearing (abnormal Pediatric Assessment Triangle)?
Pediatric Assessment Triangle = appearance, work of breathing, circulation (see Evidence for details)

Result:

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Management

Management of invasive bacterial infections in infants:

  • Prompt initiation of broad spectrum antibiotics according to local guidelines is strongly recommended.
  • Optimize respiratory support and hemodynamics if respiratory distress or signs of dehydration or shock are present.
  • Inpatient hospital admission for a minimum of 36-48 hours is recommended if cultures remain negative.

Studies indicate that 96% of blood cultures will become positive by 36 hours and 99% will become positive by 48 hours, if invasive bacterial infection is present (Biondi 2014, Biondi 2015).

Critical Actions

No decision rule should trump clinical gestalt. High suspicion for IBI in a febrile infant should warrant full sepsis workup.

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