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Febrile infant

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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Guidelines

1.Diagnostic investigations

Blood tests: consider obtaining inflammatory markers in well-appearing 8-21 days old infants.
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  • Urine tests

  • CXR

2.Diagnostic procedures

Cerebrospinal fluid 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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3.Medical management

Setting of care: 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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  • Antibiotic therapy (general principles)

  • Antibiotic therapy (parenteral)

  • Antibiotic therapy (oral)

  • Antibiotic therapy (discontinuation)

4.Specific circumstances

Patients with febrile seizures: 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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5.Follow-up and surveillance

Hospital discharge criteria: discharge hospitalized 8-21 days old infants if all of the following areMET :
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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