What is included in the emergent workup for neonates with fever?

Updated: Jul 23, 2019
  • Author: Hina Z Ghory, MD; Chief Editor: Russell W Steele, MD  more...
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Answer

Answer

Guidelines have been applied to neonatal emergency medicine. Traditionally, a febrile neonate (temperature >100.4°F [>38°C]) undergoes a full sepsis workup, which includes a CBC count, urinalysis, blood culture, urine culture, chest radiography, and diagnostic LP. The age group that is defined for this workup may vary. At minimum, the guideline is applied to neonates younger than 28 days, and in some institutions or regions of the country, it may be applied to infants as old as 60 days.

A full evaluation for sepsis in febrile neonates is warranted because their risk for serious bacterial infection (SBI) is relatively high. Even among those who otherwise meet low-risk criteria, the rates of SBI are about 5%. [37, 36]

Similarly, about 10% of febrile neonates who have documented respiratory syncytial virus (RSV) infection or clinical bronchiolitis have SBI [44] ; most of these are urinary tract infections (UTIs). This infection rate is about the same as for those without documented RSV infection or clinical bronchiolitis; therefore, a full evaluation for sepsis should be performed for these patients.

Cerebrospinal fluid analysis

For infants younger than 28 days, the median CSF values were as follows:

  • WBC count – 5/µL (range, 0-20)

  • Glucose - 46 mg/dL

  • Protein - 73 mg/dL

One study determined that adding polymerase chain reaction (PCR) testing for enterovirus to routine CSF testing reduced the duration of hospitalization and antibiotic use for young infants. [45]

Another study determined normal CSF profiles among a large cohort of febrile infants with atraumatic LPs, negative CSF bacterial cultures, and negative enteroviral PCR testing. [46]


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