Management of young, febrile infants. Primum non nocere revisited.

Abstract

The difficulty in diagnosing bacterial in newborns by clinical examination has long been recognized and emphasized. 1 Fever in is of great concern and, operationally in most nurseries, is regarded as indicative of infection, warranting evaluation (a sepsis workup) and treatment. 1,2 However, until the last decade, the literature contained little consideration of the appropriate management of a febrile infant who is old enough to be discharged from the hospital but still very young, in the first weeks of life. The prevailing policy in most university centers seemed to be routine hospitalization of febrile neonates and antibiotic treatment after culturing CSF, blood, and urine. 3 This bias, extrapolated from nursery experience, was reinforced by McCarthy and Dolan 4 ; they reviewed the records of 22 infants, 3 months of age or younger, with a temperature of 40 °C (104 °F) or higher and reported the serious implications of such