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Febrile infant

Guidelines

Key sources

The following summarized guidelines for the evaluation and management of febrile infant are prepared by our editorial team based on guidelines from the American Academy of Pediatrics (AAP 2021), the American Academy of Family Physicians (AAFP 2019), and the American College of Emergency Physicians (ACEP 2016). ...
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Diagnostic investigations

Blood tests: as per AAP 2021 guidelines, consider obtaining inflammatory markers in well-appearing 8-21 days old infants.
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More topics in this section

  • Urine tests

  • CXR

Diagnostic procedures

CSF analysis: as per AAP 2021 guidelines, obtain CSF analysis (WBC, protein, glucose, Gram stain) and bacterial culture in well-appearing febrile 8-21 days old infants.
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Medical management

Setting of care: as per AAP 2021 guidelines, hospitalize well-appearing febrile 22-28 days old infants in a facility with nurses and staff experienced in the care of neonates/young infants when CSF is not obtained or is uninterpretable.
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More topics in this section

  • Antibiotic therapy (general principles)

  • Antibiotic therapy (parenteral)

  • Antibiotic therapy (oral)

  • Antibiotic therapy (discontinuation)

Specific circumstances

Patients with febrile seizures: as per AAFP 2019 guidelines, do not obtain routine diagnostic testing, such as laboratory tests, neuroimaging, or EEG, in well-appearing pediatric patients with a simple febrile seizure.
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Follow-up and surveillance

Hospital discharge criteria: as per AAP 2021 guidelines, discharge hospitalized 8-21 days old infants if all of the following are MET:
culture results are negative for 24-36 hours or only positive for contaminants
the infant continues to appear clinically well or is improving (such as fever, feeding)
no other reasons for hospitalization.
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