Emergency clinicians frequently provide care to febrile infants aged ≤60 days in the emergency department. In these very young infants, fever may be the only presenting sign of invasive bacterial infection and, if untreated, invasive bacterial infection can lead to severe outcomes.
Our recent issue Febrile Infants Aged ≤60 Days: Evaluation and Management in the Emergency Department reviews newer risk-stratification tools and the 2021 American Academy of Pediatrics clinical practice guideline to provide recommendations for the evaluation and management of febrile young infants.
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Here are a few key points:
- The 2021 American Academy of Pediatrics (AAP) clinical practice guideline has updated recommendations, including evaluation and management strategies that differ for 3 distinct age groups: (1) 8 to 21 days, (2) 22 to 28 days, and (3) 29 to 60 days.
- Febrile infants aged ≤21 days and ill-appearing infants of any age should have a urinalysis, with urine culture if the urinalysis is positive, blood culture, and cerebrospinal fluid (CSF) testing; receive empiric antibiotic therapy; and be hospitalized.
- CSF testing is no longer routinely recommended for well-appearing febrile infants aged 22 to 60 days with normal inflammatory markers, regardless of urinalysis results.
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