II. Indications

  1. Assessment of febrile infant (>38.0 C or 100.4 F) aged 28-56 days
  2. Reassures against serious infection (Occult Bacteremia)

III. Criteria: Reassuring if all criteria are present

  1. Well appearing infant
    1. Alert and active
    2. Normal respiratory status
    3. Normal muscle tone
  2. Reassuring examination
    1. Not dehydrated
    2. No signs of focal infection
      1. No Otitis Media
      2. No soft tissue infection
      3. No bone or joint infection
  3. Labs
    1. White blood count (WBC) <15,000/mm3
    2. Urinalysis <5-10 WBC/hpf
    3. Urine Gram Stain Negative for Bacteria
    4. Urine Leukocyte Esterase and nitrite negative
    5. CSF <10 WBC/mm3
    6. Chest XRay no infiltrate (if obtained)

IV. Interpretation

  1. Higher risk
    1. Management per local protocol for possible Occult Bacteremia
  2. Lower risk (all reassuring criteria met)
    1. Supports discharge with antibiotics (Ceftriaxone 50 mg/kg IM)
    2. Close interval follow-up within 24 hours

VI. References

  1. Herman (2015) Crit Dec Emerg Med 29(12):14-19
  2. Hui (2012) Evid Rep Technol Assess (205):1-297 +PMID:24422856 [PubMed]

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