Fever in infants and children

Diagnostic markers of serious bacterial infections in febrile infants younger than 90 days old

“…The management of febrile illnesses in infants <90 days of age varies considerably among physicians . Part of this variability is probably associated with the wide range of management protocols tested and reported throughout the past decades . Following the more conservative guidelines, most physicians hospitalize the majority of febrile infants <3 months old and initiate empirical antibiotic therapy.…”

“…As of 2005, the routine evaluation of febrile infants at Dana‐Dwek Children's Hospital Emergency Department included the measurement of CRP level, thus providing us with the ability to compare CRP to other inflammatory markers. Many algorithms have used peripheral WBC in the evaluation of febrile infants, mostly because of the widespread availability of testing it in both office‐ and hospital‐based settings and its proven value in the evaluation of older infants . Surprisingly, however, recent studies have shown only a modest discriminatory power of WBC to identify bacterial infections .…”

“…The most commonly accepted approach worldwide is to identify which infants are at high risk of SBI and need to be hospitalized for i.v. empirical antibiotic treatment and which ones are at low risk for SBI and can safely undergo outpatient care with or without antibiotics . The efficacy and safety of outpatient management of febrile infants thought to be at low risk for SBI have been reported in three large studies .…”

“…Testing for WBC is familiar to emergency physicians as being simple, readily available, yielding prompt results, and inexpensive. Its use has long been the cornerstone of many protocols for distinguishing between low‐ and high‐risk febrile infants . Recent studies, however, reported that the contribution of WBC to detection of SBI was only minor, and many reports have supported the importance of C‐reactive protein (CRP) level as being superior to many other laboratory values, including WBC .…”

Sepsis Workup in Febrile Infants 0–90 Days of Age With Respiratory Syncytial Virus Infection

“…9 Current reviews are unanimous in recommending sepsis workup of febrile infants under 90 days of age without any clear focus of infection. [23][24][25] No one wants to risk omitting a serious bacterial infection in the febrile young infant. The finding of a lower rate of complete sepsis workup in patients with wheezing suggests that the clinicians were more comfortable accepting RSV infection as the sole source of fever in these patients.…”