>The Febrile Infant

ED Rounds – Dec 2018

Dr. Robin Clouston


Objectives

  • Discuss the risk of serious bacterial infection (SBI) in the neonate or young infant (<90d) with fever
  • Review current suggestions for the work up, management, disposition, and follow up in the care of neonates and young infants with fever
  • Discuss the role of decision tools (ex: Rochester, Boston, Philadelphia) to aid in decision making for the well-appearing infant with fever

Introduction

  • •The febrile neonate (<28d) and young infant (<90d) are commonly encountered in the emergency dept.
  • Many will have a self limited, viral illness
  • A small but significant proportion (up to 15%1 in some series) will have a serious bacterial infection (SBI)
  • How to best assess and manage such infants has long been a matter of debate.

Definitions

  • Neonate: 0 to 28d
  • Young Infant <90d
  • Fever = rectal temp >/= 38.0C
  • Serious bacterial infections (SBI) include:
    • Bacterial meningitis, bacteremia, UTI, pneumonia
    • Some series: enteritis, cellulitis, abscess, osteomyelitis, septic joint
  • Invasive Bacterial Infect (IBI)
    • Bacterial meningitis and bacteremia

Common Pathogens

  • In neonates < 28d, most common pathogens are:
    • E. coli
    • Group B streptococcus
    • S. pnuemoniae
    • S. aureus
    • L. monocytogenes
    • Also:
      • Herpes simplex virus
      • Respiratory syncytial virus
      • Enterovirus

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