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Triage and stabilization
Immediate priorities
Fever definition
Rectal temperature 38.0 C or higher
Immediate risk flags
Toxic appearance
Lethargy
Inconsolability
Poor perfusion
Cyanosis
Apnea
Seizure
Persistent vomiting
Respiratory distress
Resuscitation triggers
Shock physiology
Tachycardia out of proportion
Hypotension
Capillary refill 3 seconds or longer
Cool extremities
Altered mental status
Escalate to resuscitation bay for any shock physiology
Airway and breathing targets
Oxygen saturation 94 percent or higher
Work of breathing normalization
Circulation targets
Normotension for age
Capillary refill under 2 seconds
Urine output 1 mL per kg per hour or higher
Monitoring
Continuous pulse oximetry
Cardiac monitoring
Frequent reassessment of perfusion and mental status
Vascular access
Peripheral IV
IO if IV access delayed and unstable
Initial risk stratification 29 to 60 days
Risk groups
Population definition
Age 29 to 60 days
Previously healthy
Born at 37 weeks gestation or later
No chronic medical condition
No indwelling hardware
No immunodeficiency
No recent hospitalization
Exclusion features
Prematurity under 37 weeks gestation
Complex congenital heart disease
Chronic lung disease with oxygen requirement
Immunocompromise
Central line or VP shunt
Recent antibiotics within 48 hours
Clinical appearance branch
Ill appearing pathway
Full sepsis evaluation
Empiric parenteral antibiotics
Hospital admission
Well appearing pathway
Urinalysis plus inflammatory markers plus blood culture
Lumbar puncture based on inflammatory markers and shared decision-making
Key clinical decision points
Decision nodes
Inflammatory markers definition
Procalcitonin
C reactive protein
Absolute neutrophil count
Abnormal inflammatory markers
Temperature over 38.5 C
Procalcitonin over 0.5 ng per mL
C reactive protein over 20 mg per L
Absolute neutrophil count over 4000 to 5200 per microL
Urinalysis interpretation
Positive leukocyte esterase
Positive nitrite
Pyuria over 5 WBC per hpf
Low risk well appearing definition
Urinalysis negative
Inflammatory markers normal
No focal bacterial source
High risk well appearing definition
Any abnormal inflammatory marker
Urinalysis suggestive of UTI
Clinician concern despite normal markers
Lumbar puncture decision
Perform LP if ill appearing
Perform LP if abnormal inflammatory markers and no alternative source
Consider LP if urinalysis positive and inflammatory markers abnormal
Shared decision-making for LP if borderline markers and reliable follow-up
SymptomDx is an educational tool for medical professionals. It does not replace clinical judgment. Verify all clinical data and drug dosages with authoritative sources.