Infectious Disease Book

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Rochester Criteria for Febrile Infant 0 to 60 days

Aka: Rochester Criteria for Febrile Infant 0 to 60 days, Rochester Criteria for Febrile Infants, Rochester Criteria for Infant with Fever, Febrile Infant Evaluation with Rochester 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. Philadelphia Criteria for Febrile Infant 29-60 days
    5. Milwaukee Criteria for Febrile Infant 28-56 days
    6. Boston Criteria for Febrile Infant 28-89 days
    7. Yale Scale for Febrile Child 3 to 36 months
    8. Pediatric Sepsis
    9. Neonatal Sepsis
    10. Fever Without Focus Red Flags
  2. Indications
    1. Assessment of febrile child (>38 C) aged less than 60 days
    2. Reassures against serious infection (Occult Bacteremia)
  3. Criteria: Reassuring if all criteria are present
    1. Well appearing infant
    2. No skeletal, soft tissue, skin or ear infections
    3. Full term birth
    4. No prior illness
      1. No prior hospitalizations
      2. Not hospitalized longer than mother after delivery
      3. No prior antibiotics
      4. No Hyperbilirubinemia
      5. No chronic or underlying illness
    5. Complete Blood Count normal
      1. White Blood Cell Count normal (5000 to 15,000/mm3)
      2. Band Neutrophils < 1,500/mm3
    6. Other Lab Findings
      1. If Diarrhea is present, Fecal Leukocytes <5 WBC/hpf
      2. Urine White Blood Cells <10 WBC/hpf
  4. Interpretation: Occult Bacteremia risk
    1. Well-appearing febrile infant risk: 7-9%
    2. All Rochester reassuring criteria present: <1%
      1. Supports discharge to home with close follow-up and no empiric antibiotics
  5. Efficacy
    1. Test Sensitivity: 92%
    2. Test Specificity: 50%
    3. Positive Predictive Value: 12.3%
    4. Negative Predictive Value: 98.9%
  6. References
    1. Dagan (1985) J Pediatr 107:855-60 [PubMed]
    2. Jaskiewicz (1994) Pediatrics 94:390-6 [PubMed]

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