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.
1.
If over 6 months and has had 3 doses each of Hib and PCV7
vaccine
2.
If under 6 months or has not had 3 doses each of Hib and
PCV7 vaccine
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
1.
If
blood culture positive admit for parenteral antibiotics and sepsis evaluation.
2.
If
urine culture positive and ill admit for parenteral antibiotics