Fever in Infants ≤ 60 days

Thank you to the following content expert who led the development of the Fever in Infants ≤ 60 days Bottom Line Recommendations and Algorithm:

Brett Burstein, MDCM, PhD, MPH, FRCPC, FAAP

Associate Professor, Department of Pediatrics, Faculty of Medicine and Health Sciences, McGill University, Pediatric Emergency Medicine Physician, Montreal Children’s Hospital

Thank you to the TREKK Editorial Committee, Editor Dr. Sarah Reid (CHEO), and CHRIM Parent and Youth Advisory Committee who provided editorial support and expertise in the development of this resource. Thank you as well to Mateja Carevic, TREKK Project Coordinator (University of Manitoba) who coordinated the development process.

(as cited in the Fever in Infants Bottom Line Recommendations):

1. McCulloh RJ, McDaniel LM, Kerns E, Biondi EA. Prevalence of Invasive Bacterial Infections in Well-Appearing, Febrile Infants. Hosp Pediatr. Sep 2021;11(9):e184-e188. doi:10.1542/hpeds.2020-002147.
2. Burstein B, Lirette MP, Beck C, Chauvin-Kimoff L, Chan K. Management of well-appearing febrile young infants aged ≤90 days. Paediatr Child Health. 2024 Feb 6;29(1):50-66. doi: 10.1093/pch/pxad085. PMID: 38332970; PMCID: PMC10848123.
3. Bonadio WA, Hegenbarth M, Zachariason M. Correlating reported fever in young infants with subsequent temperature patterns and rate of serious bacterial infections. Pediatr Infect Dis J. 1990 Mar;9(3):158-60. doi: 10.1097/00006454-199003000-00002. PMID: 2336295.
4. Caring For Kids. Fever and temperature taking. Accessed January 15, 2022, https://caringforkids.cps.ca/handouts/health-conditions-and-treatments/fever_and_temperature_taking
5. Mintegi S, Gomez B, Carro A, Diaz H, Benito J. Invasive bacterial infections in young afebrile infants with a history of fever. Arch Dis Child. 2018 Jul;103(7):665-669. doi: 10.1136/archdischild-2017-313578. Epub 2018 Feb 15. PMID: 29449214.

6. Ramgopal S, Janofsky S, Zuckerbraun NS, Ramilo O, Mahajan P, Kuppermann N, Vitale MA. Risk of Serious Bacterial Infection in Infants Aged ≤60 Days Presenting to Emergency Departments with a History of Fever Only. J Pediatr. 2019 Jan;204:191-195. doi: 10.1016/j.jpeds.2018.08.043. Epub 2018 Oct 2. PMID: 30291019.

7. Grover G, Berkowitz CD, Lewis RJ, Thompson M, Berry L, Seidel J. The effects of bundling on infant temperature. Pediatrics. 1994 Nov;94(5):669-73. PMID: 7936893.
8. Kuppermann N, Dayan PS, Levine DA, et al. A Clinical Prediction Rule to Identify Febrile Infants 60 Days and Younger at Low Risk for Serious Bacterial Infections. JAMA Pediatr. Apr 1 2019;173(4):342-351. doi:10.1001/jamapediatrics.2018.5501
9. Aronson PL, Shabanova V, Shapiro ED, et al. A Prediction Model to Identify Febrile Infants </=60 Days at Low Risk of Invasive Bacterial Infection. Pediatrics. Jul 2019;144(1)doi:10.1542/peds.2018-3604
10. Velasco R, Gomez B, Labiano I, Mier A, Ugedo A, Benito J, Mintegi S. Performance of Febrile Infant Algorithms by Duration of Fever. Pediatrics. 2024 May 1;153(5):e2023064342. doi: 10.1542/peds.2023-064342. PMID: 38563061
11. Thomson J, Sucharew H, Cruz AT, et al. Cerebrospinal Fluid Reference Values for Young Infants Undergoing Lumbar Puncture. Pediatrics. Mar 2018;141(3)doi:10.1542/peds.2017-3405
12. Aronson PL, Wang ME, Nigrovic LE, et al. Time to Pathogen Detection for Non-ill Versus Ill-Appearing Infants </=60 Days Old With Bacteremia and Meningitis. Hosp Pediatr. Jul 2018;8(7):379-384. doi:10.1542/hpeds.2018-0002
13. Alpern ER, Kuppermann N, Blumberg S, Roosevelt G, Cruz AT, Nigrovic LE, Browne LR, VanBuren JM, Ramilo O, Mahajan P; PEDIATRIC EMERGENCY CARE APPLIED RESEARCH NETWORK (PECARN). Timeto Positive Blood and Cerebrospinal Fluid Cultures in Febrile Infants ≤60 Days of Age. Hosp Pediatr. 2020 Sep;10(9):719-727. doi: 10.1542/hpeds.2020-0045. PMID: 32868377; PMCID: PMC7446544.
14. Coughlin KW. Medical decision-making in pediatrics: Infancy to adolescence. Paediatr Child Health. May 2018;23(2):138-146. doi:10.1093/pch/pxx127
15. Sylvestre P, Aronson PL, Yannopoulos A, Poirier C, Gaucher N, Burstein B. Parental Preferences and Shared Decision-Making for the Management of Febrile Young Infants. Pediatrics. Sep 17 2024;154(4)doi:10.1542/peds.2024-066420

16. Curfman AL, Glissmeyer EW, Ahmad FA, et al. Initial Presentation of Neonatal Herpes Simplex Virus Infection. J Pediatr. May 2016;172:121-126 e1. doi:10.1016/j.jpeds.2016.02.015

17. James SH, Kimberlin DW. Neonatal Herpes Simplex Virus Infection. Infect Dis Clin North Am. Sep 2015;29(3):391-400. doi:10.1016/j.idc.2015.05.001
18. Cruz AT, Nigrovic LE, Xie J, et al. Predictors of Invasive Herpes Simplex Virus Infection in Young Infants. Pediatrics. Sep 2021;148(3)doi:10.1542/peds.2021-050052
19. Mahajan P, Browne LR, Levine DA, et al. Risk of Bacterial Coinfections in Febrile Infants 60 Days Old and Younger with Documented Viral Infections. J Pediatr. Dec 2018;203:86-91 e2. doi:10.1016/j.jpeds.2018.07.07
20. Burstein B, Yannopoulos A, Dionne KA. Urinary Tract Infection, Bacteremia, and Meningitis Among Febrile Young Infants With SARS-CoV-2 and Non-SARS-CoV-2 Viral Infections. JAMA Netw Open. Jun 1 2023;6(6):e2321459. doi:10.1001/jamanetworkopen.2023.21459
21. Blaschke AJ, Korgenski EK, Wilkes J, et al. Rhinovirus in Febrile Infants and Risk of Bacterial Infection. Pediatrics. Feb 2018;141(2)doi:10.1542/peds.2017-2384

For a complete list of the evidence that informed the creation of the Fever in Infants Bottom Line Recommendations and Algorithm see the Evidence Repository here.

To see our resource development process please visit our website here.