›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.