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Traditional strategies for the evaluation of febrile young infants (younger than 90 days of age)

Traditional strategies for the evaluation of febrile young infants (younger than 90 days of age)
  Boston criteria Milwaukee criteria Philadelphia criteria Rochester criteria
Age range
  • 28 to 89 days
  • 28 to 56 days
  • 29 to 60 days
  • ≤60 days
Temperature
  • ≥38.0°C
  • ≥38.0°C
  • ≥38.2°C
  • ≥38.0°C
History*
  • No immunizations within last 48 hours
  • No antimicrobial within 48 hours
  • Not dehydrated
  • Not defined
  • Not defined
  • Term infant
  • No perinatal antibiotics
  • No underlying disease
  • Not hospitalized longer than the mother
Physical examination*
  • Well appearing
  • No sign of focal infection (middle ear, soft tissue, bone/joint)
  • Well appearing (normal breathing, alert, active, normal muscle tone)
  • Not dehydrated
  • No sign of focal infection (middle ear, soft tissue, bone/joint)
  • Well appearing
  • Unremarkable examination
  • Well appearing
  • No sign of focal infection (middle ear, soft tissue, bone/joint)
Laboratory parameters*
  • CSF <10/mm3
  • WBC <20,000/mm3
  • UA <10 WBCs/hpf
  • Chest radiograph: no infiltrate (if obtained)
  • CSF <10/mm3
  • WBC <15,000/mm3
  • UA <5 to 10 WBCs/hpf (no bacteria, negative LE/nitrite)
  • Chest radiograph: no infiltrate (if obtained)
  • CSF <8/mm3
  • WBC <15,000/mm3
  • UA <10 WBCs/hpf
  • Urine Gram stain negative
  • CSF Gram stain negative
  • Chest radiograph: no infiltrate
  • Stool: no blood, few or no WBCs on smear (if indicated)
  • Band-neutrophil ratio <0.2
  • CSF: NA (no lumbar puncture is indicated)
  • WBC >5000 and <15,000/mm3
  • ABC <1500
  • UA ≤10 WBCs/hpf
  • Stool: ≤5 WBCs/hpf smear (if indicated)
Management strategy for low risk
  • Home/outpatient
  • Empiric antibiotics
  • Follow-up required
  • Reliable caretaker followup required
  • IM ceftriaxone 50 mg/kg followed by re-evaluation within 24 hours
  • Home/outpatient
  • No antibiotics
  • Followup required
  • Home/outpatient
  • No antibiotics
  • Follow-up required
Management strategy for high risk
  • Hospitalize
  • Empiric antibiotics
  • Not defined
  • Hospitalize
  • Empiric antibiotics
  • Hospitalize
  • Empiric antibiotics
ABC: absolute band count; C: Celsius; CSF: cerebrospinal fluid; hpf: high-power field; UA: urinalysis; WBC: white blood cells.
* The evaluation algorithms rate patients as normal/low risk versus high/not low risk for serious bacterial infection based on information in each of these domains. The example values in the table represent low risk.
Reproduced from: Hui C, Neto G, Tsertsvadze A, et al. Diagnosis and management of febrile infants (0-3 months). Evid Rep Technol Assess 2012; (205):1. Available at: https://effectivehealthcare.ahrq.gov/products/febrile-infants-diagnosis-management/research (Accessed March 23, 2021).
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