Pedi Fever



Suggested Guidelines for the Evaluation and Management of Neonates, Infants, and Children with Fever, Who Are Well Appearing, Have Had All Relevant Immunizations, and No Clinical Source for Fever
Age Group Evaluation Disposition

ABx

Bacteremia Sepsis Meningitis
0–28 d*
38°C (100.4°F)


SBI incidence of ill appearing: 13%–21%;
if not ill appearing: <5%
CBC
Blood culture
UA w/ C&S
LP:
CSF cell count
WBC
Gram stain, & culture.
 
Flu Swab, RSV.
CXR is opt., if no respiratory symptoms.
 
Stool testing if diarrhea is present.
Admit.
&
IV ABx
 
  Ampicillin 100 mg/kg/day q6h
and
Cefotaxime 50 mg/kg
or

Gentamicin 4 mg/kg/day q12h
Ampicillin 100 mg/kg/day q6h
and
Cefotaxime 50 mg/kg
or

Gentamicin 4 mg/kg/day q12h
29–56 d*
(1-2 Mo)
38.2°C (100.8°F) (Philadelphia Protocol)

SBI incidence of ill appearing: 13%–21%; if not ill appearing: <5%
Same as for neonates.
LP Optional is source of infection identified.
Discharge if:
WBC 15,000/mm3 and 5000/mm3 and <20% band forms.
Urinalysis negative.
CSF WBC <10 cells/mm3.
Negative chest x-ray or fecal leukocytes if applicable.

Admit if any of above criteria are not met
and
IV ABx

Ceftriaxone 50 mg/kg   Ampicillin 100mg/kg
PLUS
Cefotaxime 50mg/kg

OR

Ceftriaxone 50 mg/kg
PLUS consider
Vancomycin 15mg/kg
Ampicillin 100mg/kg
PLUS
Cefotaxime 100mg/kg

OR

Ceftriaxone100 mg/kg
PLUS 
Vancomycin 15mg/kg .
> 90 days
(> 3 Mo)
Rapid Strep
Mono Spot
CXR
UA
 
Discharge: If clinically doing well, tolerating PO intake Ceftriaxone 50mg/kg Cefotaxime 50mg/kg
or
Ceftriaxome 50mg/kg
plus consider
Vancomycin 15mg/kg
Cefotaxime 100mg/kg
or
Ceftriaxome 100mg/kg
plus 
Vancomycin 15mg/kg
57 d* - 6 mo*
(2-6 Mo)
38°C (100.4°F)

Non-UTI SBI incidence is estimated to be negligible
UTI is 3%–8%
Urinalysis and urine culture alone.
or
For conservative management, treat infants 57–90 d using Philadelphia Protocol above.
Discharge if negative.
Treat for UTI with
- Cefixime 8 mg/kg/d daily or divided twice a day, or
- cefpodoxime 10 mg/kg/d divided twice a day, or
- Cefdinir 14 mg/kg/d divided every 12–24 h for 7–10 d as outpatient.

Admit and treat with IV ceftriaxone if fails conservative criteria for discharge.
     
57 d to 6 mo*
(2-6 Mo)
39°C (102.2°F)

SBI incidence is estimated <1%; non-UTI SBI incidence is estimated to be negligible.
UTI is 3%–8%
Urinalysis and urine culture alone.
or
Urinalysis and urine culture in addition to CBC and blood culture.
Discharge if negative.
 
Treat for UTI as above.
If WBC 15,000/mm3, consider treatment with
- Ceftriaxone, 50 mg/kg IV/IM, and follow-up in 24 h.
If WBC 20,000/mm3, consider chest x-ray and CSF testing.
     
6–36 Mo (3 yr)
 
Non-UTI SBI incidence is < 0.4%
UTI in girls < 8%
UTI in boys (<12 mo) < 2%
Uncircumcised boys (1–2 y) remains 2%
Urinalysis and urine culture.
Girls 6–24 mo.
Boys 6–12 mo.
Uncircumcised boys 12–24 mo.
Discharge if negative.

Treat for UTI as above as outpatient.

     
3yr and older Rapid Strep
Mono Spot
Flu Swab, RSV
CXR
UA
Discharge and treat with
- Acetaminophen 15 mg/kg PO/PR every 4 h
or
- Ibuprofen, 10 mg/kg PO every 6 h prn.