Febrile Infant Quick Guide
Clinical Decision Making for Well-Appearing Febrile Infants Without Identifiable Source of InfectionPlease refer to CMH CPG for full work up and antibiotic recommendations (0-21 Days, 22-28 days, 29-60 days)This tool does not take into account patient’s HSV risk status. Please consider your individual’s patient’s risk when utilizing. |
0-21 Days of Age |
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Inflammatory Markers |
Urinalysis |
Lumbar Puncture |
Antibiotics |
Disposition |
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Positive or Negative |
Positive or Negative |
Perform LP |
IV antibiotics |
Admit^ |
22-28 Days of Age |
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Urinalysis |
Lumbar Puncture |
Antibiotics |
Disposition |
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Negative |
Negative |
LP may be obtained* |
LP not performed à option to admit off antibiotics ------------------------------------------- LP performedàMay give IV antibiotics* (required if CSF (+))# |
Observe in hospital^
-------------------------------------- May discharge home if CSF (-), Ceftriaxone x 1 given* and f/u in 24-36 hours available |
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Negative |
Positive |
LP may be obtained* |
IV antibiotics |
Admit^ |
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Positive |
Positive or Negative |
Perform LP, then: --------------------------------------- If CSF is negative
---------------------------------------- If CSF is positive ----------------------------------------- If CSF is not obtained or uninterpretable |
IV Antibiotics if UA positive -------------------------------------- If UA negative and observing at home IV antibiotics
If UA negative and admitting may administer IV antibiotics* ---------------------------------------- IV antibiotics ----------------------------------------- IV antibiotics |
Admit^
------------------------------------------- Admit^ ------------------------------------------- Admit^
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29-60 Days of Age |
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Inflammatory Markers |
Urinalysis |
Lumbar Puncture |
Antibiotics |
Disposition |
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Negative |
Negative |
No LP |
No antibiotics |
Observe closely at home, f/u in 24-36 hours |
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Negative |
Positive |
No LP |
Oral antibiotics |
Observe closely at home, f/u in 24-36 hours |
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Positive |
Negative |
Perform LP, then: |
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Positive |
Positive |
May perform LP*, then: IF CSF is negative ------------------------------------------ If CSF is positive# ------------------------------------------- If CSF is not obtained or uninterpretable |
IV or oral antibiotics (if UA(+)) --------------------------------------- IV antibiotics ---------------------------------------- IV Antibiotics |
May observe in hospital or home* ----------------------------------------- Admit^ ----------------------------------------- May observe in hospital or home* |
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^Discharge at 24-36 hours if cultures negative and clinically improving * Opportunity for Shared Decision Making # CSF positive defined as >15 WBC/mm3
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ELEVATED INFLAMMATORY MARKERS (IM) • Procalcitonin > 0.5 ng/mL • C-reactive protein (CRP) ≥ 2.0 mg/dl (20 mg/L) • Absolute neutrophil count (ANC) > 4,000 • Temperature > 38.5oC |
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These pathways do not establish a standard of care to be followed in every case. It is recognized that each case is different, and those individuals involved in providing health care are expected to use their judgment in determining what is in the best interests of the patient based on the circumstances existing at the time. It is impossible to anticipate all possible situations that may exist and to prepare a pathway for each. Accordingly, these pathways should guide care with the understanding that departures from them may be required at times.