Febrile infant update.
OBJECTIVE
The approach to febrile young infants remains challenging. This review serves as an update on the care of febrile infants less than 90 days of age with a focus on the changing epidemiology of serious bacterial infection (SBI), refinement of management strategies based on biomarkers, and the development of novel diagnostics.


RESULTS
There is high variability in the emergency department management of febrile young infants without significant differences in outcomes. C-reactive protein (CRP) and procalcitonin have emerged as valuable risk-stratification tests to identify high-risk infants. When interpreting automated urinalyses for suspected urinary tract infection (UTI), urine concentration influences the diagnostic value of pyuria. Novel diagnostics including RNA biosignatures and protein signatures show promise in better identifying young febrile infants at risk of serious infection.


CONCLUSIONS
The majority of febrile infants with an SBI will have a UTI but the diagnosis of invasive bacterial infection in infants continues to be challenging. The use of procalcitonin and CRP as biomarkers in prediction algorithms facilitates identification of low-risk infants.
Division of Emergency Medicine, Boston Children's Hospital, Boston, Massachusetts, USA.
Kate
K
Dorney
Richard G
RG
Bachur
D000465:Algorithms; D001424:Bacterial Infections / Q000150:complications / Q000175:diagnosis* / Q000378:metabolism; D015415:Biomarkers / Q000378:metabolism; D003661:Decision Support Techniques; D004636:Emergency Service, Hospital; D005334:Fever / Q000209:etiology / Q000628:therapy*; D006801:Humans; D007223:Infant; D007231:Infant, Newborn; D011379:Prognosis; D018570:Risk Assessment; D014552:Urinary Tract Infections / Q000150:complications / Q000175:diagnosis / Q000378:metabolism
D015415:Biomarkers