›Urine catheter specimen for urinalysis and culture
›Lumbar puncture early unless unstable
›Inflammatory markers
›Viral testing if it changes isolation or cohorting local protocol dependent
Empiric antimicrobials
›Empiric antibiotics for age 0 to 28 days
›Ampicillin IV
›Typical dosing 50 mg per kg per dose local protocol dependent
›Interval based on postnatal age and renal function local protocol dependent
›Gentamicin IV
›Typical dosing 4 to 5 mg per kg per dose local protocol dependent
›Interval based on gestational age and renal function local protocol dependent
›Cefotaxime IV alternative local protocol dependent
›Consider if meningitis suspected or aminoglycoside avoidance needed
›Avoid ceftriaxone in neonates local protocol dependent
HSV coverage when indicated
›Empiric acyclovir triggers
›Vesicular rash
›Seizure
›Ill appearance without source
›Elevated AST or ALT
›Maternal primary HSV near delivery
›Acyclovir IV regimen
›Typical dosing 20 mg per kg every 8 hours local protocol dependent
›Renal dose adjustment required
Fluids and hemodynamics
›Shock management
›Isotonic fluid bolus 10 to 20 mL per kg if poor perfusion
›Reassess perfusion after each bolus
›Early vasoactive support if fluid refractory shock local protocol dependent
Temperature and comfort measures
›Antipyresis
›Acetaminophen dosing per kg local protocol dependent
›Avoid masking clinical deterioration
Reassessment loop
›Reassessment triggers
›Repeat vitals within 30 to 60 minutes
›Perfusion reassessment after fluids
›Mental status trend
›New focal findings
Consultation plan
›Consultations
›Pediatrics or neonatology
›Infectious diseases for HSV or unusual pathogens local protocol dependent
›ICU for shock or respiratory failure
17Disposition/dispo22
Level of care criteria
›ICU criteria
›Shock or vasoactive support
›Apnea or respiratory failure
›Seizure requiring escalation
›Inpatient admission criteria
›All infants age 0 to 28 days with fever typically admitted local protocol dependent
›Positive urinalysis pending culture
›Abnormal inflammatory markers
›CSF pleocytosis or abnormal CSF indices
Observation pathway criteria
›Observation pathway local protocol dependent
›Age 22 to 28 days well appearing
›Normal inflammatory markers
›Normal urinalysis
›Reliable follow up within 24 hours
Transfer criteria
›Transfer triggers
›Need for pediatric ICU unavailable on site
›Need for neonatal specialty care unavailable on site
Discharge criteria
›Discharge rare and protocol dependent
›Age 22 to 28 days only in select pathways
›All studies low risk per local protocol
›Caregiver reliability high
›Clear return precautions and follow up arranged
18Discharge Instructions/di10
Copy discharge instructions
›Fever in a newborn can be a sign of a serious infection even if your baby looks well
›If your baby has a temperature 38.0 C or higher measured rectally return to the emergency department immediately
›If your baby is hard to wake return immediately
›If your baby is feeding poorly return immediately
›If your baby has fewer wet diapers than usual return immediately
›If your baby has trouble breathing return immediately
›If your baby turns blue or has pauses in breathing return immediately
›If your baby develops a new rash especially purple spots return immediately
›Do not give any new medications unless instructed by a clinician
›Follow up timing within 24 hours if discharged under a pathway
19References/r15
Guidelines and landmark sources
›American Academy of Pediatrics Clinical Practice Guideline Evaluation and Management of Well Appearing Febrile Infants 8 to 60 Days Old 2021
›Age range does not include 0 to 7 days
›Local protocol required for 8 to 28 day application
›National Institute for Health and Care Excellence Fever in under 5s assessment and initial management latest update local protocol dependent
›High risk group includes infants younger than 3 months with fever
›Recommends urgent assessment and investigation in young infants
›Canadian Paediatric Society Position Statements on fever in young infants and serious bacterial infection pathways local protocol dependent
›Canadian context for testing and admission practices
›Emphasizes low threshold for full evaluation in neonates
›Infectious Diseases Society of America guidance on management of neonatal HSV local protocol dependent
›Supports early empiric acyclovir when clinical risk factors present
›Emphasizes CSF and blood PCR testing
›PECARN febrile infant prediction rule original validation study
›Requires specific lab inputs
›Must match inclusion criteria for safe use
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.