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Febrile infant
Guidelines
Key sources
The following summarized guidelines for the evaluation and management of febrile infant are prepared by our editorial team based on guidelines from the American Academy of Pediatrics (AAP 2021), the American Academy of Family Physicians (AAFP 2020,2019), and the American College of Emergency Physicians (ACEP 2016).
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Diagnostic investigations
General principles
As per AAFP 2020 guidelines:
Obtain a diagnostic evaluation for neonates < 28 days of age with fever ≥ 38 °C, including a thorough history, physical examination, CBC, blood cultures, lumbar puncture, urinalysis, and urine culture.
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Obtain a diagnostic evaluation for febrile children between 28 days and 3 months of age, including a thorough history, physical examination, and urinalysis. Consider performing a lumbar puncture, but it is not suggested for all patients in this age range.
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Blood tests
Urine tests
CXR
Diagnostic procedures
Medical management
Setting of care: as per AAP 2021 guidelines, hospitalize well-appearing febrile infants 22-28 days of age in a facility with nurses and staff experienced in the care of neonates/young infants when CSF is not obtained or is uninterpretable.
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Antibiotic therapy (general principles)
Antibiotic therapy (parenteral)
Antibiotic therapy (oral)
Antibiotic therapy (discontinuation)
Specific circumstances
Follow-up and surveillance
Hospital discharge criteria: as per AAP 2021 guidelines, discharge hospitalized infants 8-21 days of age if all of the following are met:
culture results are negative for 24-36 hours or only positive for contaminants
the infant continues to appear clinically well or is improving (such as fever, feeding)
no other reasons for hospitalization.
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