title: Outpatient management of selected young febrile infants without antibiotics.
abstract: OBJECTIVE
  To analyse the outpatient management of selected febrile infants younger than 90 days without systematic lumbar puncture and antibiotics.
  
  
  METHODS
  A prospective registry-based cohort study including all the infants ≤90 days with fever without a source (FWS) who were evaluated in a paediatric emergency department (ED) over a 7-year period (September 2007-August 2014). We analysed the outcome of those infants with low-risk criteria for serious bacterial infection (SBI) managed as outpatients without antibiotics and without undergoing a lumbar puncture. Low-risk criteria: Well appearing, older than 21 days of age, no leucocyturia, absolute neutrophil count ≤10 000, serum C reactive protein ≤20 mg/L, procalcitonin <0.5 ng/mL and no clinical deterioration during the stay in the ED (always <24 hours).
  
  
  RESULTS
  1472 infants with FWS attended the ED. Of these, 676 were classified to be at low risk for SBI without performing a lumbar puncture. After staying <24 hours in the short-stay unit of the ED, 586 (86.6%) were managed as outpatients without antibiotics. Two patients were diagnosed with SBI: one occult bacteraemia and one bacterial gastroenteritis. Both were afebrile when evaluated again and did well. No patient returned to the ED due to clinical deterioration. Fifty-one infants (8.7%) returned to the ED mainly due to persistence of fever or irritability. None was diagnosed with definite SBI or non-bacterial meningitis.
  
  
  CONCLUSIONS
  Outpatient management without antibiotics and systematic lumbar puncture is appropriate for selected febrile infants younger than 3 months of age with close follow-up.
authors.affiliation: Paediatric Emergency Department, Cruces University Hospital. University of the Basque Country, Bilbao, Spain.
authors.forename: Santiago
authors.initials: S
authors.lastname: Mintegi
authors.affiliation: Paediatric Emergency Department, Cruces University Hospital. University of the Basque Country, Bilbao, Spain.
authors.forename: Borja
authors.initials: B
authors.lastname: Gomez
authors.affiliation: Paediatric Emergency Department, Cruces University Hospital. University of the Basque Country, Bilbao, Spain.
authors.forename: Lidia
authors.initials: L
authors.lastname: Martinez-Virumbrales
authors.affiliation: Paediatric Emergency Department, Cruces University Hospital. University of the Basque Country, Bilbao, Spain.
authors.forename: Oihane
authors.initials: O
authors.lastname: Morientes
authors.affiliation: Paediatric Emergency Department, Cruces University Hospital. University of the Basque Country, Bilbao, Spain.
authors.forename: Javier
authors.initials: J
authors.lastname: Benito
mesh_terms: D000553:Ambulatory Care / Q000379:methods; D001424:Bacterial Infections / Q000175:diagnosis* / Q000628:therapy; D004636:Emergency Service, Hospital / Q000706:statistics & numerical data; D005334:Fever / Q000628:therapy*; D006801:Humans; D007223:Infant; D007231:Infant, Newborn; D011446:Prospective Studies; D012042:Registries; D016896:Treatment Outcome; D019564:Unnecessary Procedures
keywords: fever; infant; low-risk; outpatient management