In a clinical practice guideline issued by the American Academy of Pediatrics and published in Pediatrics, key action statements are presented for the management of well-appearing infants aged 8-60 days with a fever of 38 degrees Celsius or higher. The writing committee developed the guidelines for the evaluation and management of well-appearing febrile infants aged 8-21 days, 22-28 days, and 29-60 days. For infants aged 8-21 days, the authors recommend obtaining a urine specimen by catheterization or suprapubic aspiration of the bladder for urinalysis (UA) and for culture if the UA is positive. A blood culture should be obtained; inflammatory markers may be assessed. Cerebrospinal fluid (CSF) should be obtained for analysis and cul- tured for bacteria. Parenteral antimicrobial ther- apy should be initiated. While awaiting results of bacterial culture, infants should be actively monitored in the hospital setting by experienced nurses and staff. If culture results are negative for 24-36 hours or are positive only for contam- inants, the infant continues to appear clinically well or is improving, and there are no other rea- sons for hospitalization, parenteral antimicrobials should be discontinued and patients discharged. Bacterial pathogens in urine, blood, or CSF should be treated with targeted antimicrobial therapy. “As we learn more about the risks and benefits of treating infants, we offer evidence- based recommendations for physicians to con- sider,” a co-author said in a statement. “We also acknowledge the significant role that parents play in the decision-making process as informed participants in the process.”
