in regards to nenatal fever...the standard has been changing -- thankfully
First: All neonates are not the same. A 6 week old is not a 2 week old in
development or immunology.
Second: To say that a clinician can tell which 14 day old has serious bacterial
illness - even if you just talk about bacterial meningitis ans bacteremia --
goes against every bit of data and most of our personal experience. I'll give
you a clinical exam on a 7 week old but not on a child less than one month.
only people who advocate a "mini sepsis workup" on those kids are a small group
of practitioners and the Rochester group. With all due respect to the
group, their criteria are flawed because their study population was distorted.
Furthermore, the Rochester Criteria DO NOT work in this age group (see APA
abstract No. 112 in AJDC, April 1993). As for the practitioner, the LMD does
not see enough well appearing febrile infants less than one month to pass
judgement. Chances are the LMD will not miss a case because they never
a case. To make a global recommendation takes data from thousands of patients.
With that said I suggest that all febrile kids less than one month have a
complete sepsis w/u including LP and should be hospitalized for at least a day
or two. Empiric antibiotics are up to you if the w/u is negative. Kids 1-2
months who look well should still have a full work-up but if the tests are
negative, they can be managed as outpatients without antibiotics. I'm more
flexible in my approach to the 6-8 week old and I don't think kids with a real
OM need a full w/u if they look well.
Albert Einstein College of Medicine
Bronx, NYneonatal fever
For more information, send mail to [log in to unmask] with the message: info PED-EM-L
The URL for the PED-EM-L Web Page is: