Clinical Practice Guideline: Evaluation and Management of Well-Appearing Febrile Infants 8 to 60 Days Old

Abstract

This guideline addresses the evaluation and management of wellappearing, term infants, 8 to 60 days of age, with fever $38.0 C. Exclusions are noted. After a commissioned evidence-based review by the Agency for Healthcare Research and Quality, an additional extensive and ongoing review of the literature, and supplemental data from published, peer-reviewed studies provided by active investigators, 21 key action statements were derived. For each key action statement, the quality of evidence and benefit-harm relationship were assessed and graded to determine the strength of recommendations. When appropriate, parents' values and preferences should be incorporated as part of shared decision-making. For diagnostic testing, the committee has attempted to develop numbers needed to test, and for antimicrobial administration, the committee provided numbers needed to treat. Three algorithms summarize the recommendations for infants 8 to 21 days of age, 22 to 28 days of age, and 29 to 60 days of age. The recommendations in this guideline do not indicate an exclusive course of treatment or serve as a standard of medical care. Variations, taking into account individual circumstances, may be appropriate. BACKGROUNDEfforts to develop an evidence-based approach to the evaluation and management of young febrile infants have spanned more than 4 decades. 1 In the 1970s, concerns arose about the emergence and rapid progression of group B Streptococcus (GBS) infection in neonates, whose clinical appearance and preliminary laboratory evaluations did not always reflect the presence of serious disease. 2 Such concerns led to extensive evaluations, hospitalizations, and antimicrobial treatment of all febrile infants younger than 60 days, 3 with many institutions extending complete sepsis workups to 90 days. However, the seminal

Predictor of Early Administration of Antibiotics and a Volume Resuscitation for Young Infants with Septic Shock

“…Young infants (aged < 90 days) have a high risk of developing serious infections leading to sepsis due to their greater susceptibility to pathogens. In the past four decades, enormous efforts have been made to develop an evidence-based approach for evaluating young febrile infants [ 1 ]. Some research groups have aimed to develop prediction models including clinical variables, such as age, and laboratory examinations, including peripheral white blood cell counts (WBCs) and urine tests, to rule out serious bacterial infections (SBIs) [ 2 , 3 ].…”

Limited Utility of SIRS Criteria for Identifying Serious Infections in Febrile Young Infants

“…Young infants (aged < 90 days) have a high risk of developing serious infections (SIs) due to their greater susceptibility to pathogens and problems with clinical examination that may cause potential infections to be overlooked [1,2]. Traditionally, the clinical care of febrile young infants has focused on identifying serious bacterial infections requiring early intervention with antibiotics.…”

Evaluation of the FilmArray Meningitis/Encephalitis Panel for Detection of Pathogenic Microorganisms in Cerebrospinal Fluid Specimens

“…The FilmArray Meningitis/Encephalitis (ME) Panel (BioFire Diagnostics, LLC, Salt Lake City, UT, USA) is new molecular method of multiplex polymerase chain reaction (PCR) testing that can detect the 14 most common pathogens in central nervous system infections [3,4]. In this study, we compared the performance of the FilmArray ME Panel with that of conventional methods for diagnosing infectious meningitis and encephalitis.…”