Febrile Infant.

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Presentation transcript:

Febrile Infant

Febrile infant <3 months age (Temperature >38C) Neonate (0-28 days): Admit, Full septic workup, empiric antibiotics Young Infant (28-90 days) High risk, toxic appearance: Admit, full septic workup, empiric antibiotics Low risk, non-toxic appearance: Full septic workup +\- LP based on clinical judgment Normal Lab Evaluation: Outpatient management with oral antibiotics and reliable follow-up ensured Abnormal chest X-ray or abnormal urinalysis: Admit to hospital for antibiotics

Rochester Criteria for Febrile Infants: (Age 60-90 Days) Well Appearing\ Full Term No Skeletal, Soft Tissue, Skin, or ear infection Previously healthy WBC 5000 – 15,000 Bands <1500 UA: WBC’s <10\hpf If Diarrhea: fecal Leukocytosis <5\hpf Interpretation: Well appearing febrile infant risk: 7-9% All Rochester Criteria present: <1%

Management (febrile infant 28-90Days): Low Risk Outpatient: Full sepsis workup and empiric parenteral antibiotic coverage (Ceftriaxone IV\IM)

Yale Observation Scale: (3-36 Months) Toxic appearance Quality of cry Reaction to parents Arousability Color Hydration Social Response Interpretation: Risk increase with higher scores

Low Risk infant Previously healthy\Full term No focal bacterial infection on PE Good social situation Non toxic clinical appearance Negative lab screening WBC 5000-15000 <1500 bands Normal UA <5 WBCs’hpf in stool if diarrhea present

Most common bacterial organisms: (0-28 Days) Group B Strep E. coli Listeria

Antibiotic: Ampicillin and Gentamicin OR Ampicillin and Cefotaxime

Most common bacterial organisms: (28-90 Days) Latent onset Croup B strep H. Flu Strep Pneumonia N. Meningitis