Rabiner et al reported criteria for identification of a febrile infant less than 2 months of age who is at low risk for a serious bacterial infection. This can help to identify an infant that can be treated conservatively. The authors are from New York Presbyterian-Morgan Stanley Children's Hospital, Columbia University, Northwell Health, Albert Einstein College of Medicine, University of Miami and Maimonides Medical Center in Brooklyn.
Patient selection: febrile (>= 38°C rectal) neonate <= 56 days
Management protocol:
(1) all neonates <= 28 days of age and ill-appearing infants 29-56 days of age
(2) blood, urine and CSF studies
(3) admitted for empiric antibiotic therapy
Serious bacterial infection: bacterial growth of a known pathogen with 1,000 colony-forming units per mL in blood, urine, CSF or stool cultures.
The most common pathogens isolated were E. coli and Group B Streptococcus.
Criteria for low-risk infant:
(1) 29 to 56 days of age
(2) well-appearing
(3) reliable caregiver
(4) follow-up available
(5) WBC count between 5,000 and 15,000 per µL
(6) ratio of immature to total neutrophil ratio < 0.2
(7) < 10 WBC per high power field in urinalysis
(8) normal blood glucose
(9) normal liver function tests
(10) normal CSF (if tested)
(11) normal chest X-ray (if available)
(12) negative fecal leukocytes (if tested)
Close follow-up of low-risk infants is important for detection of any possible serious infection detected on screening cultures.
