pediatric fever 0 to 28 daysMANAGEMENT

PEDIATRIC-SPECIFIC PRESENTATIONS · 12 SECTIONS

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473 items

☷ Legend

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Cardiovascular Presentations71▾

Respiratory Presentations52▾

Neurological Presentations83▾

Gastrointestinal Presentations74▾

Genitourinary and Reproductive Presentations48▾

Infectious Disease Presentations148▾

Trauma Presentations89▾

Toxicologic Presentations80▾

Psychiatric Presentations26▾

Musculoskeletal and Rheumatologic Presentations96▾

Dermatology Presentations23▾

Environmental and Exposure Presentations27▾

Hematologic and Oncologic Presentations36▾

Pediatric-Specific Presentations19▾

Bronchiolitis Croup Ductal-dependent congenital heart disease Emergency delivery Febrile seizure Hypercyanotic (tet) spell Inborn error of metabolism Intussusception Kawasaki disease Necrotizing enterocolitis Neonatal jaundice Neonatal resuscitation Nursemaid's elbow Pediatric DKA and cerebral edema Pediatric fever 0 to 28 days Pediatric fever 29 to 60 days Pediatric fever 61 to 90 days Pediatric septic shock Pyloric stenosis

Endocrine and Metabolic Presentations45▾

ENT and Maxillofacial Presentations27▾

Ophthalmologic Presentations19▾

Obstetric Presentations23▾

Systemic and Miscellaneous Presentations17▾

01Approach to the Critical Patient/attcp57

Triage priorities

›High-risk age group

›0 to 28 days with rectal temperature 38.0 C or higher

›Serious bacterial infection risk even if well appearing

›Treat as sepsis until proven otherwise

›Immediate escalation triggers

›Apnea

›Cyanosis

›Poor perfusion

›Lethargy

›Seizure

›Hypotension

›Initial monitoring

›Continuous pulse oximetry

›Cardiac monitor

›Noninvasive blood pressure cycling

›Temperature trend

Stabilization

›Airway and breathing

›Supplemental oxygen for SpO2 below local target

›Bag-mask ventilation for apnea or inadequate ventilation

›Early airway support for recurrent apnea or shock

›Circulation

›Vascular access within 5 minutes

›Peripheral IV

›If delayed, intraosseous

›Fluid resuscitation

›If shock, isotonic crystalloid 10 mL/kg bolus

02History/hx56

Fever characterization

›Fever details

›Highest temperature

›Method of measurement

›Antipyretic exposure

›Time course

›Onset time

›Duration

›Trend

›Vaccines

›Immunization in prior 48 hours

›Birth hepatitis B timing

Symptoms and functional change

›Feeding and hydration

›Intake decrease

›Emesis

›Wet diaper count

›Respiratory

›Cough

›Tachypnea

›Apnea

›Neurologic

›Lethargy

›Irritability

›Seizure activity

›Gastrointestinal

›Diarrhea

›Blood in stool

03Physical Exam/exam51

Appearance and vitals

›General appearance

›Toxic appearance

›Weak cry

›Poor tone

›Vital signs interpretation

›Fever 38.0 C or higher

›Hypothermia as sepsis marker

›Tachycardia out of proportion to fever

›Tachypnea

›Hypotension late sign

›Perfusion

›Capillary refill

›Central pulses

›Mottling

Focused system exam

›HEENT

›Bulging fontanelle

›Conjunctivitis

›Otitis signs

›Respiratory

›Work of breathing

›Focal crackles

›Grunting

›Cardiovascular

›Murmur

›Hepatomegaly

›Differential pulses

04Differential Diagnosis/ddx32

Life-threatening

›Invasive bacterial infection

›Bacteremia

›ICD-10 R78.81

›Bacterial meningitis

›ICD-10 G00.9

›Neonatal sepsis

›ICD-10 P36.9

›HSV infection

›Disseminated HSV

›HSV CNS disease

›Pneumonia

›ICD-10 J18.9

›Urinary tract infection

›ICD-10 N39.0

›Osteomyelitis or septic arthritis

›Osteomyelitis ICD-10 M86.9

›Septic arthritis ICD-10 M00.9

Other important causes

›Viral illness

›RSV

›Influenza

›SARS-CoV-2

›Enterovirus

›Congenital infection

›TORCH considerations

›Serious noninfectious

›Congenital heart disease with decompensation

05Laboratory Tests/lt57

Core sepsis labs

›Baseline evaluation set

›Blood culture

›Antibiotics after collection if feasible

›Complete blood count with differential

›ANC interpretation context dependent

›WBC alone insufficient to rule out invasive infection

›CRP

›Early illness may be normal

›Serial trend more informative

›Procalcitonin

›Higher specificity for invasive bacterial infection than WBC in many pathways

›Interpretation limited in immediate neonatal period

›Chemistry

›Electrolytes

›Creatinine and urea

›Glucose mmol/L

›Blood gas if ill

›pH

›Lactate mmol/L

›PaCO2 mmHg

›PaO2 mmHg

Urine testing

›Urine assessment

›Urinalysis

›Leukocyte esterase

›Nitrites

›Microscopy WBC

06Diagnostic Tests/dt44

Scoring Systems

›Risk stratification tools context

›Many tools designed for older infants

›Neonates 0 to 28 days generally managed as high risk regardless of score

›Rochester criteria

›Historical low-risk tool

›Limited modern validation for neonates

›Philadelphia and Boston criteria

›Older criteria including routine LP

›Not aligned with current biomarker era

›Step-by-Step and PECARN febrile infant rules

›Developed for infants up to 60 to 90 days in various cohorts

›Youngest age groups typically treated as high risk in pathways

›Guideline alignment

›AAP guideline focuses on 8 to 60 days

›Institutional pathways often treat 0 to 21 days as mandatory full sepsis evaluation and admission

MRI

›CNS imaging indications

›Focal neurologic deficit

›Persistent seizures

›Suspected HSV encephalitis with abnormal neuro exam

›Practical limitations

›Need for sedation in many neonates

›Not first-line in initial ED sepsis evaluation

›Interpretation pearls

›HSV temporal involvement possible

›Diffusion restriction in meningitis complications

07Disposition/dispo24

Admission and level of care

›Default disposition

›Inpatient admission for all febrile infants 0 to 28 days

›Parenteral antibiotics pending cultures

›PICU criteria

›Shock

›Need for vasoactives

›Respiratory failure

›Recurrent apnea

›Seizure or altered mental status

›Transfer criteria

›No pediatric inpatient capability

›Need for PICU not available

›Need for lumbar puncture under specialist support

Observation endpoints

›Culture monitoring

›Blood culture time to positivity local lab dependent

›Reassessment at 24 to 36 hours common inpatient practice

›Clinical trajectory

›Feeding improvement

›Afebrile without antipyretics

›Stable vitals and perfusion

Discharge exceptions

›ED discharge generally not appropriate in 0 to 28 days

›Consider only under specialist pathway

›Requires full evaluation including CSF in most protocols

›Requires reliable follow-up and return access

08Treatment/t65

Empiric antimicrobials

›Initial empiric regimen for sepsis without focal source

›Ampicillin

›50 mg/kg IV every 6 hours for sepsis dosing

›100 mg/kg IV every 6 hours if meningitis suspected

›Listeria and Enterococcus coverage

›Gentamicin

›4 to 5 mg/kg IV every 24 hours

›Therapeutic drug monitoring per local protocol

›Nephrotoxicity and ototoxicity risk monitoring

›Alternative regimen when meningitis suspected or Gram-negative meningitis risk

›Cefotaxime

›50 mg/kg IV every 6 to 8 hours depending on age and indication

›Preferred cephalosporin in neonates when needed

›Avoid ceftriaxone in neonates

›Bilirubin displacement risk

›Calcium precipitation risk

›Vancomycin indications

›Suspected MRSA

›Central line infection

›Severe skin and soft tissue infection

›Local resistance patterns

›15 mg/kg IV per dose with interval per gestational age and renal function

HSV coverage

›Acyclovir indications

›Vesicular rash

›Seizure

›Focal neurologic signs

09Special Populations/sp19

Pregnancy

›Maternal postpartum context

›Maternal fever and chorioamnionitis history relevance

›Maternal HSV lesion history relevance

›Medication exposure through breast milk

›Generally compatible antibiotics used in neonates

›Breastfeeding support during hospitalization

Geriatric

›Not applicable group

›Pediatric-only condition framework

›Exclude from neonatal fever pathway use

Pediatrics

›Neonatal specific factors

›Corrected age consideration for prematurity

›NICU discharge infants higher baseline risk

›Febrile infant guideline context

›Many national guidelines stratify 0 to 21 days as mandatory full evaluation and admission

›22 to 28 days frequently treated similarly due to risk

›Procedural considerations

›Lumbar puncture positioning and analgesia

›Blood culture volume optimization per local lab

›Urine collection via catheter or suprapubic aspirate

10Background/b29

Epidemiology

›Fever burden in neonates

›Significant proportion viral

›Nontrivial invasive bacterial infection risk compared with older infants

›Most common serious bacterial infection

›UTI among well-appearing febrile infants

›Invasive bacterial pathogens in neonates

›E coli

›Group B Streptococcus

›Listeria monocytogenes

Pathophysiology

›Neonatal immune vulnerability

›Reduced opsonization and complement activity

›Limited neutrophil reserve in severe infection

›Hematogenous spread propensity

›Bacteremia seeding meninges

›Rapid progression without obvious focus

›HSV disease patterns

›Skin eye mouth disease

›CNS disease

›Disseminated disease with hepatitis and shock

Therapeutic Considerations

›Antibiotic selection rationale

›Ampicillin for Listeria and Enterococcus

›Aminoglycoside for Gram-negative synergy

›Cefotaxime when meningitis suspected or high Gram-negative concern

›Timing principle

›Earlier antibiotics in shock improves outcomes

11Patient Discharge Instructions/pdi25

Copy discharge instructions

›Post-hospital discharge guidance

›Follow-up timing

›Primary care visit within 24 to 48 hours after discharge

›Specialty follow-up if meningitis or HSV

›Feeding and hydration expectations

›Normal feeding frequency for age

›Wet diapers trending to baseline

›Return immediately for

›Temperature 38.0 C or higher

›Difficulty breathing

›Apnea

›Blue or pale color

›Poor feeding

›Fewer wet diapers

›Lethargy or unusual sleepiness

›Persistent vomiting

›New rash

›Seizure or abnormal movements

›Medication safety

›Only medications prescribed at discharge

›No ibuprofen unless specifically directed

›Acetaminophen dosing only if instructed

›Infection control

›Hand hygiene

›Limit sick contacts

12References/r14

Guidelines and society statements

›Febrile young infants 0 to 90 days guidance

›Canadian Paediatric Society position statement on well-appearing febrile infants 90 days or younger

›American Academy of Pediatrics guideline on well-appearing febrile infants 8 to 60 days

›NICE guideline NG143 fever in under 5s

›TREKK fever in young children and young infants resources referenced in Canadian pathways

›Neonatal HSV guidance

›CDC STI Treatment Guidelines neonatal herpes acyclovir dosing

›Canadian Paediatric Society neonatal HSV prevention and management statement

Evidence-based sources

›Febrile infant pathway evidence base

›AHRQ evidence review supporting AAP febrile infant guideline development

›Studies evaluating inflammatory markers in febrile infants

›Acyclovir dosing evidence

›Neonatal HSV dosing standard 60 mg/kg/day divided every 8 hours

›Safety literature on high-dose acyclovir in infants

Evidence & Review

Reviewed by SymptomDx Medical Team · Last reviewed August 18, 2026

SymptomDx is an educational tool for medical professionals. It does not replace clinical judgment. Verify all clinical data and drug dosages with authoritative sources.