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Uptodate Reference Title
Recommended sepsis evaluation for febrile young infants 7 to 90 days old at elevated risk for invasive bacterial infection
Recommended sepsis evaluation for febrile young infants 7 to 90 days old at elevated risk for invasive bacterial infection
Patient characteristics
Studies
All patients
CBC with differential
Blood or serum glucose (to permit comparison with CSF glucose)
Procalcitonin or C-reactive protein (optional)
Blood culture
Urinalysis
Urine culture (by bladder catheterization or suprapubic aspiration)
COVID-19 PCR (nasal swab)
Chest radiograph (if respiratory signs or symptoms present)
Stool culture (if diarrhea or stool containing blood or mucus)
CSF cell count with differential
CSF glucose and protein
CSF for bacterial culture and Gram stain
CSF PCR as indicated based upon clinical risk:
Enterovirus studies during time of high prevalence or in patients with CSF pleocytosis
HSV in infants with clinical findings or increased risk of maternal HSV transmission
CSF for viral culture if there is pleocytosis; if there is a limited CSF sample, we prioritize PCR over viral culture
Signs of septic shock*
Add:
PT, aPTT, INR
Fibrinogen and D-dimer
Serum lactate
Serum total bilirubin and ALT
Ionized calcium
Findings of HSV infection or at risk due to exposure (maternal active genital lesions)
Add:
Surface viral cultures from the conjunctivae, mouth, nasopharynx, and rectum
Swab or scraping from skin vesicles or mucous membrane lesions for direct immunofluorescence assay and viral culture
Blood PCR for HSV
Serum AST and ALT¶
Findings of bronchiolitis
Add rapid RSV testΔ
High regional prevalence of influenza
Add influenza PCRΔ
For patient characteristics that indicate an elevated risk for invasive bacterial infection and the need for a full sepsis evaluation, refer to UpToDate content on the outpatient evaluation of neonates and febrile young infants 7 to 90 days old.
CBC: complete blood count; CSF: cerebrospinal fluid; HSV: herpes simplex virus; COVID-19: coronavirus disease 2019; PCR: polymerase chain reaction; PT: prothrombin time; aPTT: activated partial thromboplastin time; INR: international normalized ratio; ALT: alanine aminotransferase; AST: aspartate aminotransferase; RSV: respiratory syncytial virus.
* Other causes of ill appearance in addition to sepsis include congenital heart disease, congenital adrenal hyperplasia, inborn errors of metabolism, malrotation with volvulus, and a variety of other conditions. Refer to UpToDate content on approach to the ill-appearing infant younger than 90 days of age.
¶ Serum alanine transaminase and aspartate transaminase to identify elevation in association with HSV-associated hepatitis; although these studies can also be elevated in patients with disseminated enteroviral infection or in septic shock.
Δ Do not use RSV or influenza test results to determine the need for antibiotics or antiviral agents to treat influenza in ill-appearing febrile young infants.