Initial approach to the infant younger than 2 months of age who presents with fever.
Fever is common in infants presenting to their physicians for evaluation. Infants younger than 2 months of age are at increased risk of SBI because of their exposure to different pathogens and because of their immature immune systems. The bacteria that may infect them include E coli, group B Streptococcus, and L monocytogenes, as well as Pneumococcus, Neisseria meningitidis, S aureus, and H influenzae. They are also susceptible to viruses, parasites, and fungi. Clinical characteristics associated with increased risk of SBI have been identified. Infants who are ill-appearing, have abnormal hemograms or urinalyses, or have evidence of bacterial infection on physical examination are at higher risk. There has been an association of very high fever with SBI, although this has been inconclusive. Clinical judgment is important, although not always completely reliable in ruling out SBI. Young infants with fever should be evaluated with a thorough history, physical examination, and selected laboratory studies. Those younger than 29 days of age should usually be admitted for observation and parenteral antibiotics. Infants from 29 to 60 days of age may be evaluated carefully and considered for outpatient management, either with or without antibiotics.
Lynn
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Department of Pediatrics, Emergency Services, Southwestern Medical School, Dallas, Texas, USA.
Wiebe
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RA