UCSF Benioff Children’s HospitalsConsensus Guidelines for Febrile Infants 0-90 Days of Age

These guidelines from the UCSF Northern California Pediatric Hospital Medicine Consortium standardize the management of community-onset fever in previously healthy infants under 90 days. They aim to reduce unnecessary testing and hospitalization while ensuring proper risk stratification based on age-specific criteria and inflammatory markers.

⚕️Key Clinical Considerations⚕️

• Age-stratified approach: Distinct management pathways for 0-21 days, 22-28 days, and 29-90 days, with all infants <21 days requiring full sepsis evaluation, hospitalization and empiric antibiotics.
• Inflammatory markers: Utilizes procalcitonin (>0.5 ng/mL), CRP (>20 mg/L), and ANC (>4000) to guide decision-making, with procalcitonin identified as the most accurate single marker.
• Limited LP criteria: CSF testing may be deferred in 29-90 day old infants with negative inflammatory markers or positive UA suggestive of UTI using shared decision making.
• HSV surveillance: Testing and empiric acyclovir indicated for specific risk factors including CSF pleocytosis, transaminitis, neurologic changes, vesicular lesions, hypothermia, or maternal HSV history.
• Discharge criteria: Well-appearing infants 22-28 days with normal labs may be discharged after antibiotics with 24-hour follow-up; 29-60 day infants with normal labs may be discharged without antibiotics if follow-up is ensured.

🎯 Clinical Practice Impact 🎯

• Patient Communication: The guidelines emphasize shared decision-making with families regarding management options, particularly for 22-90 day infants. Reliable follow-up, transportation, and parental understanding are explicitly listed as discharge criteria.
• Practice Integration: Implementation requires standardized laboratory evaluation protocols with specific cutoffs for inflammatory markers (PCT >0.5, CRP >20, ANC >4000) and coordination between ED, inpatient, and outpatient settings.
• Risk Management: Guidelines specifically exclude certain populations (bronchiolitis, focal bacterial infections, post-immunization fever) and provide clear criteria for admission versus discharge.
• Action Items: Establish 24-hour follow-up mechanisms for discharged infants, ensure culture monitoring for 5 days post-discharge, and utilize structured pathways for each age group.

More on Fever