Should We Evaluate Febrile Young Infants Step-by-Step in the Emergency Department?

Abstract

* Abbreviations: ED — : emergency department IBI — : invasive bacterial infection In this issue of Pediatrics , Gomez et al1 present a new “Step-by-Step” algorithm for management of febrile young infants. Although bacteremia and bacterial meningitis, termed invasive bacterial infection (IBI),2 occur in only 1% to 2% of febrile young infants,3,4 clinicians fear “missing” these infections due to potential for mortality and morbidity.5,6 It is longstanding practice that young febrile infants undergo a “sepsis workup,” often including lumbar puncture, and many are hospitalized to expectantly treat for bacterial infection.7 More than 2 decades ago, various criteria (Rochester,8 Philadelphia,9 and Boston10) were developed to identify febrile infants at low-risk of bacterial infection, the so-called “low-risk” criteria. Application of these criteria allows for a subset of infants >28 days of age to be safely discharged from the emergency department (ED), with or without antibiotics. However, previous studies evaluating the performance characteristics of these criteria included low numbers of infants with IBI, and varied approaches to define the subjective features of well appearance.11 In the current study, Gomez et al1 prospectively validated a “Step-by-Step” approach among >2000 febrile infants ≤90 days of age across … Address correspondence to Paul L. Aronson, MD, Section of Pediatric Emergency Medicine, Yale School of Medicine, 100 York St, Suite 1F, New Haven, CT 06511. E-mail: paul.aronson{at}yale.edu