title: Evaluation of the necessity for hospitalization of the febrile infant less than three months of age.
abstract: We reviewed records of 443 consecutive infants less than 3 months of age who were hospitalized during a 28-month period for complete evaluation of fever (rectal temperature greater than or equal to 38 degrees C), close observation and consideration of antimicrobial therapy. Infants less than 2 weeks of age were more likely to be treated with parenterally administered antibiotics than older infants (67%, 39%, 29% and 31% in the first and second two weeks of life, second and third months, respectively), and were more likely to have bacteremia and bacterial meningitis (4.8%, 2.1%, 0.5% and 2.3%, respectively), as well as serious bacterial illness (25%, 13%, 7% and 14%, respectively). Five infants (2.5% of those not initially treated) had unexpectedly positive blood (1), urine (3) or stool (1) cultures and were treated with parenteral antibiotics when culture results were known. None was less than 2 weeks of age and all had good outcomes that did not appear to be altered by the delay in diagnosis and treatment. No infant's therapy was modified as a result of clinical deterioration or persistent fever. We conclude that many febrile infants who are hospitalized "for observation" can be managed as outpatients provided that a thorough initial evaluation is performed, that parents can reliably monitor the infant closely at home and that dependable follow-up can be assured.
authors.affiliation: Tripler Army Medical Center, Honolulu, HI.
authors.forename: G M
authors.initials: GM
authors.lastname: Wasserman
authors.forename: C B
authors.initials: CB
authors.lastname: White
mesh_terms: D000367:Age Factors; D000553:Ambulatory Care; D000900:Anti-Bacterial Agents / Q000627:therapeutic use; D001424:Bacterial Infections / Q000188:drug therapy / Q000453:epidemiology*; D005260:Female; D005334:Fever / Q000188:drug therapy / Q000453:epidemiology*; D006254:Hawaii / Q000453:epidemiology; D006760:Hospitalization; D006801:Humans; D015994:Incidence; D007223:Infant; D007231:Infant, Newborn; D008297:Male
chemical_list: D000900:Anti-Bacterial Agents