Fever in Infants ≤ 60 days

This evidence repository is a collection of best available resources and evidence collated by a knowledge synthesis team at Alberta Research for Health Evidence (ARCHE) and the clinical content team.

The knowledge synthesis team utilizes a pyramid-shaped framework, built upon the “4S” hierarchy of evidence model, to provide detailed evidence appropriate to meet stakeholders’ needs. They search a combination of databases (Cochrane Library, PubMed, TRIP Database) and web-based search engines (Google, Google Scholar) to locate evidence for the knowledge pyramids. Publication types sought in the initial topic searches are organized into five levels that determine the order in which resources are presented:

1. Bottom Line Recommendations
2. Clinical Practice Guidelines and Pathways
3. Overviews and Summaries of Systematic Reviews
4. Systematic Reviews
5. Key Studies

Where applicable resources for families and parents are also listed.

The knowledge synthesis team collaborates with the clinical content team to select the most relevant guidelines, reviews, and key studies, which can be found below. This evidence repository is not intended to be an exhaustive list of resources for a topic, but rather a curated list of current, evidence-based resources, based on expert consensus of relevance and usability for a general emergency department setting. Every effort is made to identify resources that are open access (i.e. publicly available, free of charge, not requiring a subscription).

More information about the creation of our evidence repositories can be found here.

Thank you to the following clinical content experts and Knowledge Synthesis team who led the development of this evidence repository.

Brett Burstein, MDCM, PhD, MPH, FRCPC, FAAP; Clinician Scientist, Pediatric Emergency Medicine, Montreal Children’s Hospital, McGill University Health Centre; Associate Professor, McGill University, Department of Pediatrics and Department of Epidemiology, Biostatistics and Occupational Health

Liza Bialy, BSc, MPH, Knowledge Synthesis Project Coordinator, Alberta Research Centre for Health Evidence, Department of Pediatrics, University of Alberta

Sarah Elliott, PhD, Assistant Director, Alberta Research Centre for Health Evidence, Department of Pediatrics, University of Alberta

TREKK developed resources for healthcare providers and parents & families can be found here.

1. Cipriano F, Gesteland P, Jensen K, et al. Risk assessment and management of febrile infant (3-60 days. Intermountain Canyons and Desert Regions. 2025.
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.
3. Pantell RH, Roberts KB, Adams WG, et al. Evaluation and management of well-appearing febrile infants 8 to 60 days old. Pediatrics. 2021;148(2).

1. Murtagh Kurowski E, Bhatt S, Reeves S. Clinical guideline synopsis of evaluation and management of well-appearing febrile infants aged 8 to 60 days. JAMA Pediatr. 2022;176(6):602-3.
2. Ramgopal S, Wilson PM, Florin TA. Diagnosis and management of neonatal herpes simplex infection in the emergency department. Pediatr Emerg Care. 2020;36(4):196-202.
3. Woll C, Neuman MI, Aronson PL. Management of the febrile young infant: Update for the 21st century. Pediatr Emerg Care. 2017;33(11):748-53.
4. DePorre AG, Aronson PL, McCulloh RJ. Facing the ongoing challenge of the febrile young infant. Crit Care. 2017;21(1):68.
5. Coughlin KW. Medical decision-making in pediatrics: Infancy to adolescence. Paediatr Child Health. May 2018;23(2):138-146. doi:10.1093/pch/pxx127
6. 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

1. Burstein B, Sabhaney V, Bone JN, et al. Prevalence of bacterial meningitis among febrile infants aged 29-60 days with positive urinalysis results: A systematic review and meta-analysis. JAMA Netw Open. 2021;4(5):e214544.
2. Craig JV, Lancaster GA, Williamson PR, Smyth RL. Temperature measured at the axilla compared with rectum in children and young people: systematic review. BMJ. 2000 Apr 29;320(7243):1174-8.
3. Biondi EA, Lee B, Ralston SL, et al. Prevalence of bacteremia and bacterial meningitis in febrile neonates and infants in the second month of life: A systematic review and meta-analysis. JAMA Netw Open. 2019;2(3):e190874.
4. Rosenfeld-Yehoshua N, Barkan S, Abu-Kishk I, et al. Hyperpyrexia and high fever as a predictor for serious bacterial infection (SBI) in children-a systematic review. Eur J Pediatr. 2018;177(3):337-44.

1. Burstein B, Wolek C, Poirier C, et al. Optimizing management of febrile young infants without serum procalcitonin. Pediatrics. 2025 Feb 1;155(2):e2024068200.
2. 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. 2024 Oct 1;154(4):e2024066420.
3. Palladino L, Woll C, Aronson PL. Febrile infants aged ≤60 days: evaluation and management in the emergency department. Pediatr Emerg Med Pract. 2024 Feb;21(2):1-28. Epub 2024 Feb 1.
4. 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. 2023 Jun 1;6(6):e2321459.
5. Burstein B, Alathari N, Papenburg J. Guideline-based risk stratification for febrile young infants without procalcitonin measurement. Pediatrics. 2022;149(6).
6. Cruz AT, Nigrovic LE, Xie J, et al. Predictors of invasive herpes simplex virus infection in young infants. Pediatrics. 2021;148(3).
7. McCulloh RJ, McDaniel LM, Kerns E, Biondi EA. Prevalence of invasive bacterial infections in well-appearing, febrile infants. Hosp Pediatr. 2021 Sep;11(9):e184-e188.
8. Ramgopal S, Noorbakhsh KA, Pruitt CM, et al. Outcomes of young infants with hypothermia evaluated in the emergency department. J Pediatr. 2020;221:132-7.e2.
9. Ramgopal S, Janofsky S, Zuckerbraun NS, et al. Risk of serious bacterial infection in infants aged ≤60 days presenting to emergency departments with a history of fever only. J Pediatr. 2019;204:191-5.
10. 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. 2019;173(4):342-51.
11. 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. 2019;144(1).
12. 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.
13. Aronson PL, Wang ME, Nigrovic LE, et al; Febrile Young Infant Research Collaborative. Time to pathogen detection for non-ill versus ill-appearing infants ≤60 days old with bacteremia and meningitis. Hosp Pediatr. 2018 Jul;8(7):379-384.
14. Cruz AT, Mahajan P, Bonsu BK, et al. Febrile Infant Working Group of the Pediatric Emergency Care Applied Research Network. Accuracy of complete blood cell counts to identify febrile infants 60 days or younger with invasive bacterial infections. JAMA Pediatr. 2017 Nov 6;171(11):e172927. doi: 10.1001/jamapediatrics.2017.2927. Epub 2017 Nov 6. Erratum in: JAMA Pediatr. 2018 Mar 1;172(3):302.
15. Thomson J, Sucharew H, Cruz AT, et al. Pediatric Emergency Medicine Collaborative Research Committee (PEM CRC) HSV Study Group. Cerebrospinal fluid reference values for young infants undergoing lumbar puncture. Pediatrics. 2018 Mar;141(3):e20173405.
16. Mahajan P, Browne LR, Levine DA, et al. Febrile Infant Working Group of the Pediatric Emergency Care Applied Research Network (PECARN). Risk of bacterial coinfections in febrile infants 60 days old and younger with documented viral infections. J Pediatr. 2018 Dec;203:86-91.e2.
17. Powell EC, Mahajan PV, Roosevelt G, et al. Epidemiology of bacteremia in febrile infants aged 60 days and younger. Ann Emerg Med. 2018;71(2):211-6.
18. Milcent K, Faesch S, Gras-Le Guen C, et al. Use of procalcitonin assays to predict serious bacterial infection in young febrile infants. JAMA Pediatr. 2016;170(1):62-9.
19. Gomez B, Mintegi S, Bressan S, et al. Validation of the “step-by-step” approach in the management of young febrile infants. Pediatrics. 2016;138(2).
20. Curfman AL, Glissmeyer EW, Ahmad FA, et al. Initial presentation of neonatal herpes simplex virus infection. J Pediatr. 2016 May;172:121-126.e1.
21. 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.
22. 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.
23. 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
24. 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). Time to 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.
25. 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

1. Helman AJ, Joubert G. Burstein, B. Ep 173 febrile infant – risk stratification and workup. Podcast. 2022.
2. Canadian Paediatric Society. Caring for kids. Fever and temperature taking. 2020.
3. Intermountain Primary Children’s Hospital. Lumbar puncture for parents. Parent handout. 2017.