Fever survey highlights significant variations in how infants aged ≤60 days are evaluated and underline the need for guidelines.
OBJECTIVE
To assess the common practices for evaluating and treating febrile infants aged ≤60 days in a nationwide survey.


METHODS
Questionnaires were administrated to inpatient paediatric departments in all 25 hospitals in Israel.


RESULTS
Of the 25 centres surveyed (100% response rate), only 36% had written protocols concerning the approach to young febrile infants. The existence of a written protocol was significantly associated with the level of medical centre (tertiary versus primary and secondary, p = 0.041) and with the number of local paediatric infectious disease specialists (p = 0.034). In 13 (52%) hospitals, a normal white blood cell count was defined as 5000-15 000 cells/mL and 20 (80%) centres use C-reactive protein. Hospitalisation was mandatory in most (96%) centres for all neonates aged ≤28 days. Low-risk infants aged 29-60 days were hospitalised in 68.4% of the primary and secondary hospitals, compared with 33.3% tertiary centres. Ampicillin and gentamicin was the routine empiric antibiotic treatment for febrile infant in 92% of centres.


CONCLUSIONS
Significant differences exist among centres in the evaluation of febrile infants aged ≤60 days exist. These differences reflect the lack of, and highlight the need for, national or international guidelines for the evaluation of fever in this age group.
Department of Pediatrics A, Schneider Children's Medical Center, Petah Tiqva, Israel; Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel.
Havatzelet
H
Yarden-Bilavsky
Shai
S
Ashkenazi
Jacob
J
Amir
Yechiel
Y
Schlesinger
Efraim
E
Bilavsky
D000900:Anti-Bacterial Agents / Q000627:therapeutic use; D005334:Fever / Q000175:diagnosis* / Q000188:drug therapy / Q000209:etiology; D006301:Health Services Needs and Demand / Q000706:statistics & numerical data*; D006760:Hospitalization; D006801:Humans; D007223:Infant; D017410:Practice Guidelines as Topic; D010818:Practice Patterns, Physicians'; D018570:Risk Assessment; D011795:Surveys and Questionnaires
D000900:Anti-Bacterial Agents
Bacteremia; National survey; Neonatal fever; Rochester criteria; Sepsis work-up; Serious bacterial infection; Urinary tract infection