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Management of infants and young children with fever without source

Larry J Baraff1

  • 1UCLA Emergency Medicine Center, David Geffen School of Medicine at UCLA, Los Angeles, CA 90024, USA. lbaraff@mednet.ucla.edu

Pediatric Annals
|November 1, 2008
PubMed

Insights

Community pediatricians often deviate from established clinical practice guidelines for managing febrile young children. This study highlights variations in fever workups and treatment protocols for infants and children with fever without source (FWS).

Area of Science:

  • Pediatrics
  • Infectious Disease Management
  • Clinical Practice Guidelines

Background:

  • Clinical management of febrile infants and children shows significant variability.
  • Community pediatricians frequently diverge from academic training institution guidelines for fever without source (FWS).

Purpose of the Study:

  • To analyze the discrepancies in clinical management of FWS between community pediatricians and academic institutions.
  • To review current clinical practice guidelines for managing febrile neonates, infants, and children.

Main Methods:

  • Review of clinical practice guidelines for FWS management.
  • Comparison of recommended protocols with general community pediatrician practices.

Main Results:

  • Academic guidelines recommend a "full sepsis evaluation" for febrile neonates (>38.0°C).
  • Infants aged 29-90 days with FWS can be managed with low-risk criteria if non-toxic.
  • Vaccinated infants >90 days with FWS (>39.0°C) require only urinalysis and urine culture.

Conclusions:

  • There is a notable gap between recommended FWS management guidelines and community practice.
  • Guidelines suggest tailored approaches based on age, vaccination status, and clinical appearance for FWS.
  • Specific laboratory testing recommendations vary significantly by infant age and vaccination history.

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