What’s Your Diagnosis? Febrile Infants Aged ≤60 Days

Welcome to this month’s What’s Your Diagnosis Challenge!

But before we begin, check to see if you got the previous case on Management of Pediatric Urinary Tract Infections in the Emergency Department right.

Case Presentation: Febrile Infants Aged ≤60 Days: Evaluation and Management in the Emergency Department 

A full-term, well-appearing 25-day-old boy presents to the ED for evaluation of fever… 

  • The patient felt warm to the parents today but has otherwise been asymptomatic. 
  • The physical examination is normal, except for a fever of 38˚C measured rectally in the ED. 
  • What is the differential diagnosis? How should you approach evaluation and treatment? Can this baby be discharged home? 

Case Conclusion

You obtained urinalysis and inflammatory markers to detect UTI and IBI. The urinalysis showed 0 WBCs, ANC of 2300 cells/mm3, CRP of <0.5 mg/L, and PCT of 0.2 ng/mL. Since the infant was well-appearing, had a negative urinalysis and normal inflammatory markers, you performed shared decision-making with the parents and made a joint decision to defer lumbar puncture, and the infant was admitted for observation. 

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Last Updated on April 10, 2024

One thought on “What’s Your Diagnosis? Febrile Infants Aged ≤60 Days

  1. No, I will not discharge patient. Patient is 25 days old so less than 28 days, Temperature is 38 C so child needs a full sepsis work up including CBCD, CMP, Blood culture, Urinalysis, Urine culture, CSF Analysis, CSF Culture, CSF Cell Count, CSF PCR Panel, respiratory viral panel and chest X-ray. Patient will get IV Ampicillin and Ceftazidime or gentamicin if ceftazidime is not available.

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