Fever in Young Infants

Bottom line recommendations for the treatment and management of fever in neonates and infants (French). Published online: June 2019, Version 2.0.

Bottom line recommendations for the treatment and management of fever in neonates and infants. Published online: June 2019, Version 2.0.

Bottom line recommendations for the treatment and management of fever in neonates and infants (French). Published online: June 2019, Version 2.0.

The clinical pathway for treating and evaluating febrile infants is built upon publicly available medical evidence and/or a consensus of medical practitioners at The Childrens Hospital of Philadelphia.

These pathways and guidelines contain information on the assessment and management of febrile infants (0-30 days old, 31-60 days old) as inpatients and in the ED, with and without bronchiolitis.

This guideline is for fever in infants 7 to 60 days of life is elevation of central temperature to 38.0°C or higher. 

This clinical policy from the American College of Emergency Physicians addresses key issues for well-appearing infants and children younger than 2 years presenting to the emergency department with fever.

This quality standard covers the assessment and early management of fever with no obvious cause in babies and children (from birth to 5 years).

This review aimed to identify when to initiate testing and treatment for herpes simplex virus infection.

The authors highlight the historical context of febrile infant management, review important definitions and terminology, discuss the most clinically relevant viral and bacterial causes of fever in the young infant, describe current risk stratification tools guiding medicaldecision making, and outline research and clinical practice improvement priorities for improving the management of the febrile young infant.

Newer laboratory investigations such as C-reactive protein and procalcitonin have favorable test characteristics compared with traditional laboratory studies such as a white blood cell count. These novel biomarkers have not gained widespread acceptance because of lack of robust prospectively collected data, varying thresholds to define positivity, and differing inclusion criteria across studies. However, C-reactive protein and procalcitonin, when combined with other patient characteristics in the step-by-step approach, have a high sensitivity for detection of serious bacterial infection.

This study aimed to analyze a large group of febrile neonates 28 days or younger who received outpatient sepsis evaluation and nasopharyngeal aspirate antigen testing (NPAT) for respiratory syncytial viral (RSV) infection to determine whether there is a clinically significant association between viral study results and risk for serious bacterial infection (SBI: bacterial meningitis, bacteremia, urinary tract infection, bacterial enteritis).

The objective of the study was to systematically evaluate existing evidence of the diagnostic utility of biomarkers for prediction of sepsis in neonates.

This review describes diagnostic and therapeutic advances for infants with herpes simplex virus 1 (HSV-1) and 2 (HSV-2).

The objectives of this systematic review and meta-analysis were to determine: 1) the ability of serum procalcitonin concentrations to identify febrile infants < 91 days of age at high and low risk for serious bacterial infections, and 2) to compare its utility with available clinical prediction rules.

Objectives: To review the evidence for diagnostic accuracy of screening for serious bacterial illness (SBI) and invasive herpes simplex virus (HSV) infection in febrile infants 3 months or younger; ascertain harms and benefits of various management strategies; compare prevalence of SBI and HSV between different clinical settings; determine how well the presence of viral infection predicts against SBI; and review evidence on parental compliance to return for followup assessments (infants less than 6 months).

This review discusses challenges and new approaches to assessment and management of febrile children with suspected serious bacterial infections.

The objective of this systematic review was to determine the accuracy of C-reactive protein (CRP) for diagnosing serious bacterial and bacterial infections in infants and children presenting with fever.

The objective of this systematic review was to evaluate the agreement between temperature measured at the axilla and rectum in children and young people.

This prospective study aimed to develop improved tools to assess children attending ambulatory hospital care, integrating clinical features with point-of-care C reactive protein (CRP).

The objective of this study was to assess the diagnostic value of existing clinical prediction models in febrile young infants at risk for serious bacterial infections.

The objective of this study was to estimate the accuracy of individual complete blood cell count parameters to identify febrile infants with invasive bacterial infections.

The objective of this study was to evaluate the impact of a febrile young infant clinical pathway implemented in a large, urban children's hospital ED on the timeliness and consistency of care.

The objectives of this study were to assess the performance of the Yale Observation Scale score and unstructured clinician suspicion to identify febrile infants 60 days of age with and without serious bacterial infections.

The objectives of this study were to determine the incidence of bacterial meningitis among all febrile infants 29-56 days old undergoing a lumbar puncture in the emergency department of a tertiary care children's hospital and the number of low-risk febrile infants with bacterial meningitis to reassess the need for routine lumbar puncture in these infants.

The objective of this study was to describe the frequency of concomitant acute bacterial meningitis in neonates with febrile urinary tract infection.

The objective of this study was to inform the decision to test and empirically treat for herpes simplex virus (HSV) by describing the initial clinical presentation and laboratory findings of infants with a confirmed diagnosis of neonatal HSV.

The aim of this study was to analyze the usefulness of physical examination, C-reactive protein, procalcitonin, white blood cell count, and absolute neutrophils counts for the diagnosis of invasive bacterial infections and potentially serious bacterial infections in infants younger than the age of 3 months presenting with fever without source to the emergency department.

The aim of this study was to prospectively validate a sequential approach to young febrile infants on the basis of clinical and laboratory parameters, and compare it with the Rochester criteria and the Lab-score.

The objective of this study was to assess the diagnostic characteristics of the procalcitonin assay for detecting serious bacterial infection and invasive bacterial infection in febrile infants aged 7 to 91 days.

The objective of this study was to evaluate the accuracy of leukocyte count for the detection of serious bacterial infections in febrile children.

This study analyzed all cultures of blood, urine and cerebrospinal fluid obtained from full-term infants 1 week to 3 months of age, who presented during a 7-year period. Compared with earlier studies, urinary tract infections (UTIs) are now found significantly more often than bacteremia and meningitis with 92% of occult infections associated with UTIs. These data emphasize the importance of an urinalysis in febrile infants.

The objective of this study was to assess the diagnostic accuracy of white blood cell count, absolute neutrophil count, and C-reactive protein in detecting severe bacterial infections in well-appearing neonates with early onset fever without source and in relation to fever duration.

The objectives of this study were (1) to assess the rate of bacteremia in febrile infants less than 3 months of age admitted to a pediatric emergency department at a tertiary hospital; (2) to describe the bacteria isolated; and (3) to analyze factors related to increased probability of having a positive blood culture.

The objective of this study was to determine the potential predictive power of C-reactive protein as a marker of serious bacterial infection in hospitalized febrile infants aged < or =3 months.

The objective of this study was to determine the unique clinical and laboratory features of neonates with and without herpes simplex virus infection admitted to Texas Children's Hospital during a 14-year period.

The objective of this study was to determine whether bundling elevates rectal and/or skin temperature of young infants.

Fevers are the body’s natural response to infection. It can be scary when your child has a fever, but fevers will not hurt your child. This video provides information about how to take your child’s temperature, how to manage their symptoms, and when to seek health care.

This video was created through a collaboration between ECHO Research (University of Alberta), TREKK, and ARCHE (University of Alberta). Funding was provided by the Networks of Centres of Excellence and the Stollery Children’s Hospital Foundation through the Women and Children’s Health Research Institute.

Fevers are the body’s natural response to infection. It can be scary when your child has a fever, but fevers will not hurt your child. This infographic provides information about how to take your child’s temperature, how to manage their symptoms, and when to seek medical care.

This infographic was created through a collaboration between ECHO Research (University of Alberta), TREKK, and ARCHE (University of Alberta). Funding was provided by the Networks of Centres of Excellence and the Stollery Children’s Hospital Foundation through the Women and Children’s Health Research Institute.