Despite all the inroads that vaccines have made to reduce the incidence and prevalence of serious bacterial infections in infants in their first few months of life, we still struggle with what to do when a 1, 2, or even 3-month old presents with a fever. How we all care for such an infant continues to show enormous variability. To help reduce some of that, Byington et al. (
doi: 10.1542/peds.2012-0127) present an evidence-based care process model (EB-CPM) tried in the Intermountain Healthcare System in Utah. The authors built a model that encourages evidence-based diagnostic testing, determination of risk for serious bacterial infection, appropriate antibiotic selection and, duration, and length of hospital stay. Using the care process model, babies admitted were more likely to have a serious bacterial infection, and those at low risk could be managed without antimicrobial therapy. Even better news is the reduction in cost per case without any infants being missed for serious bacterial infection.
If you need further reinforcement of the importance of this study, a commentary by Robert H. Pantell (
doi: 10.1542/peds.2012-1178) frames the EB-CPM approach with the role of clinical judgment, which still comes into play despite the strength of an evidence-based model. If you aren’t excited to read the Byington study and Pantell commentary yet, you must have figured out a better way to deal with febrile infants, and if so, we would love to hear about it. Otherwise, this hot study plus commentary are must-reads that should cool down the variability in our approaches to the common dilemma of the febrile infant.
