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Management of well-appearing febrile young infants aged ≤90 days

Brett Burstein1, Marie-Pier Lirette1, Carolyn Beck1

  • 1Canadian Paediatric Society, Acute Care Committee, Ottawa, Ontario, Canada.

Paediatrics & Child Health
|February 9, 2024
PubMed

Insights

Evaluating febrile infants under 90 days requires careful risk assessment for invasive bacterial infections. New guidelines suggest using risk-stratification criteria and procalcitonin testing for better management decisions.

Area of Science:

  • Pediatrics
  • Infectious Disease

Background:

  • Fever in young infants (≤90 days) presents diagnostic challenges due to practice variations.
  • While most cases are viral, identifying infants with invasive bacterial infections (IBI), such as bacteremia and meningitis, is crucial.

Purpose of the Study:

  • To provide guidance on the evaluation and management of well-appearing febrile infants aged ≤90 days.
  • To incorporate updated risk-stratification criteria and diagnostic tools like procalcitonin.

Main Methods:

  • Review of current literature and guidelines on febrile infant management.
  • Application of risk-stratification criteria for identifying infants at low risk for IBI.
  • Consideration of diagnostic testing, including procalcitonin levels.

Main Results:

  • Most well-appearing febrile infants have viral illnesses.
  • Risk-stratification aids in differentiating low-risk infants from those requiring further investigation for IBI.
  • Procalcitonin testing can support clinical decision-making.

Conclusions:

  • Management of febrile infants should balance the probability of disease with potential harms.
  • Shared decision-making with parents/caregivers is important for low-risk infants.
  • Pragmatic factors like healthcare access and follow-up influence optimal management strategies.

Keywords:
FeverInvasive bacterial infectionRisk-stratificationSerious bacterial infection

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