Evaluation and Management of Well-Appearing Febrile Infants 8 to 60 Days Old
Patient Guideline Summary
Publication Date: August 1, 2021
This patient summary means to discuss key recommendations from the American Academy of Pediatrics (AAP) for Evaluation and Management of Well-Appearing Febrile Infants 8 to 60 Days Old.
- Infants present unique difficulties in diagnosing disease.
- They do not communicate symptoms.
- They have few, usually non-specific signs of distress.
- Their resistance to infection improves rapidly during their first 2 months.
- The most important bacterial infections at this age are bacteria in the urinary system, the blood (sepsis from a localized infection somewhere in the body), and the brain (meningitis).
- This patient summary focuses on bacterial infections in infants from 8–60 days old with fever and no other signs of illness.
- Viruses are of much less concern.
- Circumstances during the first week after birth are so different that this age group was not included in the Guideline.
- The Guideline attempts to thread a narrow path between over- and under-treatment, keeping in mind the cost and risks associated with both.
- Many specifics did not present sufficient evidence to lead to recommendations.
- Much depends on the skill of the treatment team.
- Laboratory evaluation of the infant can include:
- Urine analysis
- Spinal fluid analysis
- Bacterial cultures if these tests are positive
- Blood culture for bacteria
- Blood tests (inflammatory markers such as C-reactive protein) that reflect a significant infection.
- Viral studies are less likely.
- Urine collection methods vary with the infant’s age.
- Hospitalization is likely, though treatment at home will be considered if strict criteria are met.
- Early antibiotics are usually given.
- Strict criteria determine when treatment can be ended.
- Follow-up visits will assure the continued health of the infant.
- All the above steps are subject to decisions by the treatment team with attention to age group and for each individual case.
- AAP: American Academy Of Pediatrics
Pantell RH, Roberts KB, Adams WG, Dreyer BP, Kuppermann N, O'Leary ST, Okechukwu K, Woods CR Jr; SUBCOMMITTEE ON FEBRILE INFANTS. Evaluation and Management of Well-Appearing Febrile Infants 8 to 60 Days Old. Pediatrics. 2021 Aug;148(2):e2021052228. doi: 10.1542/peds.2021-052228. Epub 2021 Jul 19. Erratum in: Pediatrics. 2021 Nov;148(5): PMID: 34281996.
The information in this patient summary should not be used as a substitute for professional medical care or advice. Contact a health care provider if you have questions about your health.