title: Management of Hospitalized Febrile Neonates Without CSF Analysis: A Study of US Pediatric Hospitals.
abstract: OBJECTIVE
  Management of febrile neonates includes obtaining blood, urine, and cerebrospinal fluid (CSF) cultures with hospitalization for empiric parenteral antibiotic therapy. Outcomes and management for neonates were compared based on whether CSF was obtained.
  
  
  METHODS
  This multicenter retrospective review of the 2002 to 2012 Pediatric Health Information System database included hospitalized infants aged ≤28 days (neonates) admitted to an inpatient ward with a diagnosis code for fever or neonatal fever. Patients admitted to an ICU or with a complex chronic condition diagnosis code were excluded. Neonates were categorized as full septic workup (FSW; charge codes for blood, urine, and CSF culture or cell count) or as partial septic workup (PSW; charge codes for blood and urine cultures only), and their data were compared.
  
  
  RESULTS
  Of 27 480 neonates with a diagnosis code for fever, 14 774 underwent the FSW and 3254 had a PSW. Median length of stay was 2 days for both groups, with no significant difference in readmissions, disposition, or parenteral antibiotic administration. Neonates with a PSW had significantly greater odds of having charge codes for additional laboratory testing and imaging, and they were more likely to receive a diagnosis code for sepsis, meningitis, or bronchiolitis.
  
  
  CONCLUSIONS
  Neonates with PSW had lengths of stay and readmission rates similar to those with FSW but were more likely to undergo additional laboratory testing and imaging. Future studies including information about clinical severity and test results may provide additional insight into the variation in practice for this patient population.
authors.affiliation: The George Washington University School of Medicine and Health Sciences, Washington, District of Columbia; and Children's National Health System, Washington, District of Columbia pbhansal@childrensnational.org.
authors.forename: Priti
authors.initials: P
authors.lastname: Bhansali
authors.affiliation: The George Washington University School of Medicine and Health Sciences, Washington, District of Columbia; and Children's National Health System, Washington, District of Columbia.
authors.forename: Bernhard L
authors.initials: BL
authors.lastname: Wiedermann
authors.affiliation: Children's National Health System, Washington, District of Columbia.
authors.forename: William
authors.initials: W
authors.lastname: Pastor
authors.affiliation: Children's National Health System, Washington, District of Columbia.
authors.forename: Jefferson
authors.initials: J
authors.lastname: McMillan
authors.affiliation: The George Washington University School of Medicine and Health Sciences, Washington, District of Columbia; and.
authors.forename: Neha
authors.initials: N
authors.lastname: Shah
mesh_terms: D001988:Bronchiolitis / Q000175:diagnosis; D005334:Fever / Q000134:cerebrospinal fluid* / Q000209:etiology / Q000628:therapy*; D006760:Hospitalization; D006776:Hospitals, Pediatric; D006801:Humans; D007231:Infant, Newborn; D008581:Meningitis / Q000175:diagnosis; D015999:Multivariate Analysis; D010818:Practice Patterns, Physicians'; D018805:Sepsis / Q000175:diagnosis; D014481:United States