Tuesday, January 28, 2014

Diagnosis and Management of the Febrile Neonate in Emergency Departments in the First Month of Life: Know What To Do?

If there’s one thing we emphasize to student and resident trainees, it is to take seriously any febrile infant in their first month of life by obtaining blood, CSF, and urine cultures and admitting these infants for antibiotics pending culture results. In fact, we might say this approach is an “automatic” for fear of missing a serious bacterial infection in this very young population.

Photo by  COD Newsroom via Flickr
Yet “automatic” is not necessarily the gold standard of care as per data shared this week by Jain et al. (doi: 10.1542/
peds.2013-1820) in a fascinating cross-sectional study of febrile infants managed in 36 different pediatric emergency departments. What the authors show is substantive variation from the gold standard in that some febrile infants were sent home as a result of this variation and/or not always treated after cultures were obtained. If you want to see if febrile babies with serious infections were missed initially by varying from a standard sepsis evaluation and hospitalization and how or why their initial presentation may have led to a variation in the recommended care plan, then don’t rule-out reading this article.

If you also don’t automatically culture and admit our youngest febrile patients, let us know what the circumstances might be. Leave a comment below or on any of our social media sites including Facebook, Twitter, or even via an eLetter to our journal.

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