I suggest reviewing the collaborative (AAP/ACEP) practice guidelines on 
management of the febrile patient between 0-36 months, published in 1993, for a comprehensive list of references. Recall that they predate routine pneumococcal & Hemophilus Influenzae immunization.

I would concur with Dr. Glaeser's approach of "masterly inactivity." The scenario represents what truly is the "art" of pediatric medicine!  

Stratifying this infant as low risk for SBI using any published guideline would NOT completely eliminate the risk of UTI or PNA or meningococcemia in this particular patient. In the final analysis, does it not distill down to whether one is a test minimizer? 


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This has been a topic of fierce debate among us today and I hope to get  some help from those who are familiar with the studies on that issue

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