›Surface swabs polymerase chain reaction local protocol dependent
›Serum alanine aminotransferase
›Blood herpes simplex virus polymerase chain reaction local protocol dependent
Point of care tests
›Bedside screening
›Glucose
›Venous or capillary blood gas if respiratory distress
›Lactate and perfusion adjunct
›Lactate in shock concern
›Trend after resuscitation
12Imaging/img30
Scoring Systems
›Febrile infant risk stratification tools
›AAP febrile infant guideline 8 to 60 days framework
›Rochester criteria
›Philadelphia criteria
›Boston criteria
›Step by Step approach
›PECARN febrile infant rule
›Tool use boundaries
›Well appearing only
›Exclusions for prematurity and comorbidity common
›Local protocol dependent implementation
MRI
›Indications uncommon and targeted
›Suspected spinal infection
›Suspected intracranial complication with stable physiology
›Limitations and cautions
›Need for sedation in infants
›Delay compared with time critical sepsis care
CT
›Indications uncommon and targeted
›Focal neurologic deficit with concern for hemorrhage
›Concern for intracranial infection complication when urgent
›Radiation and contrast cautions
›Dose minimization principle
›Contrast nephrotoxicity risk consideration
Ultrasound
›Point of care and diagnostic ultrasound roles
›Bladder volume assessment for catheterization planning
›Soft tissue abscess evaluation
›Intussusception evaluation when symptoms suggest
›Renal and bladder ultrasound
›Not acute sepsis rule out test
›Outpatient follow up consideration after first febrile urinary tract infection local protocol dependent
13Special Tests/spec16
Bedside procedures and microbiology
›Urine collection technique
›Catheterized specimen preferred for culture reliability
›Bag specimen high contamination risk
›Lumbar puncture
›Indicated in all febrile infants age 0 to 21 days unless unstable
›In age 22 to 28 days typical by protocol
›In age 29 to 60 days based on risk markers and appearance
›Blood culture technique
›Cultures before antibiotics when feasible
›Adequate volume improves yield
Respiratory viral testing
›When useful
›Bronchiolitis phenotype
›Cohorting and infection control
›Limitations
›Positive viral test does not exclude urinary tract infection
›Positive viral test does not exclude bacteremia in youngest infants
14ECG/ecg9
When indicated in febrile infant
›Indications
›Persistent tachycardia disproportionate to fever
›Poor perfusion without clear cause
›Concern for myocarditis
›Electrolyte abnormality concern
›High risk patterns
›Heart block
›Supraventricular tachycardia
›Ventricular ectopy with instability
15Assessment/ax17
Age based risk framing
›Neonate age 0 to 28 days
›High baseline risk of invasive bacterial infection
›Full sepsis evaluation typical
›Admission typical
›Young infant age 29 to 60 days
›Risk stratification using appearance and inflammatory markers
›Urinary tract infection common serious bacterial infection source
›Disposition depends on low risk criteria and follow up reliability
›Infant age 61 to 90 days
›Management more variable by local protocol
›Urinary evaluation common default
Working diagnoses to prioritize
›Fever without source in high risk age
›Bacteremia and meningitis exclusion priority
›Urinary tract infection evaluation priority
›Viral syndrome with apnea risk
›Bronchiolitis phenotype assessment
›Co infection risk in younger infants
16Plan/plan50
First 5 minutes
›Stabilization priorities
›Airway and breathing support if apnea or respiratory failure
›Oxygen if hypoxemia
›Cardiac and pulse oximetry monitoring
›Temperature confirmation
›Access and fluids
›IV or IO access if ill appearance
›Isotonic bolus 10 to 20 mL per kg if shock
›Repeat bolus if persistent shock with reassessment
Diagnostic sequencing
›Culture timing
›Blood culture before antibiotics when feasible
›Urine culture before antibiotics when feasible
›Lumbar puncture timing
›Before antibiotics when meningitis evaluation planned
›Defer only if unstable then treat first
Empiric antimicrobials local protocol dependent
›Neonate suspected sepsis age 0 to 28 days
›Ampicillin IV
›Typical dose 50 mg per kg per dose
›Interval age dependent
›Gentamicin IV
›Typical dose 4 to 5 mg per kg per dose
›Interval age dependent
›If meningitis concern
›Ampicillin IV higher dosing for meningitis
›Cefotaxime IV preferred over ceftriaxone in neonate
›Age 29 to 60 days well appearing with higher risk features
›Ceftriaxone IV or IM
›Typical dose 50 mg per kg once daily
›Avoid in neonates and consider bilirubin risk
›If meningitis concern
›Ceftriaxone IV meningitis dosing per protocol
›Add vancomycin IV per local resistance patterns if bacterial meningitis suspected
›Herpes simplex virus concern
›Acyclovir IV
›Typical dose 20 mg per kg per dose every 8 hours
›Renal dosing adjustment consideration
Fever control and comfort
›Antipyretics
›Acetaminophen 15 mg per kg per dose every 4 to 6 hours
›Maximum daily dose per local pediatric guidance
›Avoidance
›Ibuprofen avoidance under 6 months
›Aspirin avoidance in children
Reassessment loop
›Frequency and targets
›Reassess vitals within 30 to 60 minutes after interventions
›Reassess perfusion after each bolus
›Escalation triggers
›Worsening work of breathing
›Persistent poor perfusion
›New apnea
›Rising lactate or worsening acidosis
17Disposition/dispo20
Admission and level of care
›ICU criteria
›Shock requiring repeated boluses or vasoactive support
›Apnea or impending respiratory failure
›Persistent altered alertness
›Inpatient admission criteria
›Age 0 to 28 days with fever 38.0 C or higher
›Positive urinalysis with systemic features in young infant
›Abnormal inflammatory markers with bacteremia risk
›Cerebrospinal fluid pleocytosis or positive gram stain
›Social unreliability for close follow up
Observation and outpatient pathways local protocol dependent
›Possible outpatient management age 29 to 60 days well appearing
›Normal inflammatory markers by protocol
›Negative urinalysis
›No focal bacterial source requiring admission
›Reliable caregivers and access to care
›Follow up within 24 hours arranged
›Return to ED timing
›Any clinical worsening
›Persistent fever beyond expected window
›Culture callback plan
18Discharge Instructions/di28
Copy discharge instructions
›Your baby was seen for fever
›Fever in young babies can be a sign of a serious infection
›Some babies can look well early even with infection
›What we did today
›Exam and vital signs assessment
›Urine testing and cultures when indicated
›Blood testing and cultures when indicated
›Spinal fluid testing when indicated
›Medicines
›Use acetaminophen only if recommended
›Do not use ibuprofen if your baby is under 6 months
›Give antibiotics exactly as prescribed if provided
›Feeding and hydration
›Keep offering feeds frequently
›Watch wet diapers
›Come back to the emergency department now if any of these happen
›Trouble breathing
›Blue or very pale color
›Hard to wake or unusually sleepy
›Poor feeding or refuses feeds
›Fewer wet diapers than usual
›New rash with purple spots
›Seizure
›Persistent vomiting
›Your baby looks or acts worse
›Follow up
›Follow up within 24 hours as arranged
›We may call you with culture results
19References/r7
Guidelines and decision tools
›Febrile infant guidance sources
›American Academy of Pediatrics clinical practice guideline evaluation and management of well appearing febrile infants 8 to 60 days 2021
›PECARN febrile infant rule publication and validation studies
›Step by Step approach for febrile infants validation studies
›Rochester criteria original and subsequent evaluations
›Canadian Paediatric Society position statements on fever in young infants local protocol dependent
›Project instructions source
Evidence & Review
Reviewed by SymptomDx Medical Team·Last reviewed
SymptomDx is an educational tool for medical professionals. It does not replace clinical judgment. Verify all clinical data and drug dosages with authoritative sources.