1. Febrile Infant

2. 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

4. 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%

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

6. 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

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

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

9. Antibiotic:
Ampicillin and Gentamicin OR
Ampicillin and Cefotaxime

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