When is hospitalization indicated in the emergent management of pediatric patients with fever?

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

Answer

The decision to admit older neonates and young infants for presumptive sepsis should be based on several factors, including their ability to be reevaluated by a primary care provider the next day, toxic appearance, need for monitoring, need for hydration or other supportive measures, or poor social situation.

Admission is warranted for febrile infants 28-56 days old; however, these patients may be discharged home if they meet all of the following low-risk criteria [114, 115, 116, 117, 118, 119, 120] :

  • Well-appearing infant

  • No skeletal, soft tissue, skin, or ear infections

  • Full-term birth

  • No hyperbilirubinemia

  • No chronic or underlying illness

  • No previous hospitalizations

  • Not hospitalized longer than the mother after delivery

  • Did not receive antibiotics within the past 48 hours before presentation

  • No dehydration, lethargy, irritability, or wheezing

  • No focal source of infection on physical examination (except otitis media)

  • Cerebrospinal fluid (CSF) white blood cell (WBC) count < 8 per high-power field (hpf)

  • WBC 500-15,000/mm3 and band:poly ratio < 0.2

  • Urinalysis showing < 10 WBC/hpf

  • Chest radiograph without infiltrate (if obtained)

  • If diarrhea is present, fecal leukocytes < 5/hpf and urine WBCs < 10/hpf


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