What is included in the emergent workup for children 5-8 weeks old with fever?

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

Answer

Most febrile infants aged 5-8 weeks who present to the ED warrant a full evaluation for SBI because they are difficult to evaluate clinically and because ED physicians cannot ensure adequate follow-up. [47]

The threshold for performing an LP in these infants should be low; many of these infants will warrant CSF examination. In select cases, at the clinician's discretion, an LP may be omitted in well-appearing infants who have blood and urine studies obtained and when the following apply:

  • Reliable follow-up is possible in 12-24 hours

  • Clinicians are confident that parents or caretakers can comply with appropriate observation and follow-up

  • No antibiotics have been started

A recent study defined median CSF profiles among uninfected infants in this age range. [46]

  • WBC count - 3/mm3 (range, 0-11)

  • Glucose - 48 mg/dL

  • Protein - 54 mg/dL

Urine studies are important in this age group, as UTIs are a common source of SBI. [48, 49, 50] Additional studies such as stool cultures are performed selectively. Chest radiographs do not need to be obtained routinely in those without signs of respiratory disease. [51, 52]


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