The Febrile Infant: What's New?

Fever in young infants often accompanies bacterial disease. Approximately 10% of febrile infants younger than 2 months will have associated bacteriuria, bacteremia, or other bacterial disease. In spite of assertions to the contrary, “well” physical appearance does not reliably rule out the presence of bacterial disease in this population. Accordingly, the presence of fever in infants younger than 2 months demands immediate and comprehensive management. The manuscript reviews current management controversies in the evaluation and management of febrile young infants. We describe the use and applicability of various clinical predictor sets for determining which infants are at low risk for serious bacterial illness and, in particular, whether a minimum workup is required, and if so, what constitutes those necessary laboratory tests. We also discuss whether the management should vary by the age of the infant (younger than 1 month vs 1-2 months old), the practice setting (office vs the emergency department), and the presence of concurrent viral infections.