As I am just reviewing the articles on managing febrile infants, I would
refer you to the 2 articles that address infants <60 days old:
Baker, et al. Outpatient management without antibiotics of fever in selected
infants. N Engl J Med 1993;329:1437-1441
Jaskiewicz JA, et al. Febrile infants at low risk for serious bacterial
infection-an appraisal of the Rochester criteria and implications for
management. Febrile Infant Collaborative Study Group. Pediatrics. 1994;
It is difficult to compare these strategies directly since they look at
different aged children (Philadelphia 29-60 days and Rochester 0-60 days) and
they do not include the same data points; namely the Rochester criteria does
not require a LP. However, both sets of criteria aimed to be able to pick
out low risk children who you could send home WITHOUT empiric antibiotics if
all of their criteria was met. Both of these criteria have NPV's of 99.7 and
The Boston criteria included infants up to 89 days old, and like the
Philadelphia criteria required a LP to done as part of the workup. The big
difference in this study was that the low risk infants (as defined by not
meeting their criteria which included 'well appearing' as one) were sent home
WITH empiric antibiotics. No NPV is available for this study.
As a new attending and even when I was finishing up my fourth year of
residency, I continuously struggled with this aged child. It makes it
difficult to have a consensus when the studies that are published in this
area are not looking at exactly the same aged infants.
Any other thoughts from others review of the literature would be appreciated!
Traci Thoureen, MD
Duke University Medical Center
Baskin, et al. Outpatient treatment of febrile infants 28-89 days of age with
intramuscular administration of ceftriaxone. J Pediatr 1992;120:22-27.
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