Fever is defined as rectal temperature > 38°C.
Criteria for nontoxic, febrile infants 1-3 months of age
(1) nontoxic appearance, previously healthy, born full-term
(2) no current antibiotic use
(3) no evidence of skin, ear, soft tissue, joint or bone infection
(4) parents reliable and compliance with 24 hour follow-up likely
(5) WBC count 5,000 to 15,000 with <= 1,500 band forms per µL
(6) WBC count in spun urine sediment <= 10 per high power field
(7) WBC count in stool <= 5 per high power field, if diarrhea present
If these criteria are met, then the infant is at low risk for serious bacterial infection and outpatient management is acceptable.
• In the original study, < 1% of the infants listed as low risk had a serious infection and none had bacteremia.
• In those who were high risk (did not meet all of these criteria), 25% had a serious infection and 10% had bacteremia.
Infants managed by these criteria usually
(1) have cultures of blood, urine, CSF and possibly stool taken, and
(2) receive an intramuscular injection of ceftriaxone empirically.
Febrile neonates < 1 month of age
(1) should undergo a full septic workup
(2) receive parenteral antibiotics pending the results of cultures and observation in the hospital.
Nontoxic infants 3-36 months of age with fever (temperature > 39°C) or WBC > 15,000 per µL should be cultured, receive administration of empirical ceftriaxone, and be followed up at 24 hours. Reculture of blood and CSF with hospital admission for parenteral antibiotics are given if:
(1) bacteremic and still febrile or appear ill
(2) blood cultures are positive for Hemophilus influenzae or Neisseria meningitidis.
