Infectious Disease Book

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Philadelphia Criteria for Febrile Infant 29-60 days

Aka: Philadelphia Criteria for Febrile Infant 29-60 days, Philadelphia Criteria for Febrile Infant, Philadelphia Criteria for Infant with Fever, Febrile Infant Evaluation with Philadelphia Criteria
  1. See Also
    1. Fever Without Focus
    2. Fever Without Focus Management Birth to 3 Months
    3. Fever Without Focus Management 3 to 36 months
    4. Rochester Criteria for Febrile Infant 0 to 60 days
    5. Boston Criteria for Febrile Infant 28-89 days
    6. Yale Scale for Febrile Child 3 to 36 months
    7. Pediatric Sepsis
    8. Neonatal Sepsis
    9. Fever Without Focus Red Flags
  2. Indications
    1. Assessment of febrile child (>38.2 C) aged 29-60 days
    2. Reassures against serious infection (Occult Bacteremia)
  3. Criteria: Reassuring if all criteria are present
    1. Well appearing infant
    2. Reassuring examination
    3. Labs
      1. White blood count (WBC) <15,000/mm3
      2. Band to Neutrophil ratio <0.2
      3. Urinalysis <10 WBC/hpf
      4. Urine Gram Stain Negative
      5. CSF <8 WBC/mm3
      6. CSF Gram Stain Negative
      7. Chest XRay no infiltrate (if obtained)
      8. Stool without blood and few to no Fecal Leukocytes on smear (if indicated)
  4. Interpretation
    1. Higher risk
      1. Admit and start empiric antibiotics
    2. Lower risk (all reassuring criteria met)
      1. Supports discharge with antibiotics and with close interval follow-up
  5. Efficacy
    1. Test Sensitivity: 98%
    2. Test Specificity: 42%
    3. Positive Predictive Value: 14%
    4. Negative Predictive Value: 99.7%
  6. References
    1. Bachur (2001) Pediatrics 108(2): 311-6 [PubMed]
    2. Baker (1993) N Engl J Med 329:1437-41 [PubMed]
    3. Baker (2008) Clin Ped Emerg Med 9:213-20 [PubMed]

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