Fever Without Focus Management Birth to 3 Months

1. See Also
   1. Fever Without Focus
   2. Fever Without Focus Management 3 to 36 months
2. Indications (otherwise skip to Neonatal Sepsis protocol)
   1. Nontoxic appearing young infant under age 3 months
   2. Fever (over 38 C or 100.4 F)
   3. No known infectious source
3. High risk criteria for Sepsis
   1. Urinalysis positive
      1. Leukocyte esterase positive
      2. Nitrite positive
      3. White Blood Cells >5 cells/hpf on spun sample
   2. White Blood Cells >20,000 or <4100
      1. Normal WBC Count does not rule-out Meningitis
         1. Bonsu (2003) Ann Emerg Med 41:206-14
      2. Normal WBC Count does not rule-out bacteremia
         1. Bonsu (2003) Ann Emerg Med 42:216-25
   3. Fever >39.5
   4. Age <13 days
   5. References
      1. Bachur (2001) Pediatrics 108(2):311-16
4. Management: Age <1 month old or toxic appearance
   1. Admit for assessment as for Neonatal Sepsis
   2. Labs
      1. Complete Blood Count with differential
      2. Urinalysis and catheterized Urine Culture
      3. Blood Cultures
      4. Lumbar Puncture for CSF studies and culture
   3. Protocol
      1. Start IV antibiotics
      2. Observe for 48 hours
5. Management: Age 1-3 month old and non-toxic appearance
   1. See Rochester Criteria for Febrile Infants
   2. Labs
      1. Complete Blood Count with differential
      2. Urinalysis and Urine Culture
   3. Other labs to consider as indicated
      1. Blood Cultures (esp. if antibiotics given)
      2. CSF Studies (esp. if antibiotics given)
         1. Normal WBC Count does not rule-out Meningitis
            1. Bonsu (2003) Ann Emerg Med 41:206-14
      3. Stool Studies
      4. Chest XRay
   4. Criteria for home observation (24 hour follow-up)
      1. White Blood Cell count <15,000 cells/mm
      2. Absolute Neutrophil Count <10,000 cells/mm
      3. Other labs normal (e.g. UA, CSF)
      4. Consider Rochester Criteria for Febrile Infants
   5. Protocol (if criteria above are met)
      1. Consider Ceftriaxone 50 mg/kg IM
      2. Follow-up appointment within 24 hours
6. References
   1. Baraff (1993) Pediatrics 92:1-12
   2. Baraff (2000) Ann Emerg Med 36:602-14
   3. Luszczak (2001) Am Fam Physician 64(7):1219-26
   4. Sur (2007) Am Fam Physician 75:1805-11