Pediatric Fever

Infant < 28 days: Do everything & give empiric Abx (Ceftazidime, Acyclovir (HSV) & Ampicillin) ^

CBC, BMP, Blood Cx (1 set), UA, Urine Cx, LP, RVP*

^There are new guidelines regarding patients who are between 3-4 weeks of age where LP may be deferred. There is a lot of controversy still regarding its adoption.

28 days to 2 months / 1st set of vaccines: Do everything however LP & Abx dependent on PECARN Rule for Low Risk Fever

CBC, BMP, Blood Cx (1 set), UA, Urine Cx, RVP*, Pro-Calcitonin

PECARN Rule for Low Risk Fever: LP if any of the following is positive: Pro-Cal > 0.5, ANC > 4090/micoL, Positive UA (due to seeding of CNS). PECARN Rule for Low Risk Fever was done in full term infants without chronic medical problems, no prolonged NICU stay - use discretion in patients with multiple risk factors.

If performing LP, the patient will need abx (Ceftriaxone 100mg/kg) coverage pending CSF studies.

2 months - 4 months / 2nd set of vaccines: Partial Sepsis. No LP unless clinical signs of meningitis due to blood brain barrier

CBC, BMP, Blood Cx (1 set), UA, Urine Cx, RVP*.

Can consider one dose of IV ceftriaxone (75mg/kg) if WBC > 15k, WBC < 5k, or Band to Neutrophil Ratio greater than 0.2. The evidence is not very robust and practice varies.

4 months - 6 months / 3rd set of vaccines: Urine

UA, Urine Cx, RVP*

6 months - 12 months: Urine collection requirement varies

  • Females: UA, Ucx, RVP*

  • Circumcised males- No urine, RVP*

  • Uncircumcised males- Urine if fever > 48 hrs , RVP*

1- 2 years of age: Urine collection in females

  • Female: UA, UCx, RVP*

  • Males: No urine, RVP*

*RVP can be useful for finding a source of fever (calming parent anxiety, limiting atypical Kawasaki workup etc...). However, remember patients can have more than one concomitant source of illness and a positive RVP should not prevent one from finishing the appropriate workup in each age group.

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