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I too am a general pediatrician and although I wasn't there and didn't
see the pt, certainly do not see fault with such management. First of
all, a 14 wk old infant is not a neonate (unless possibly it was born
preterm and then it is less clear how those infants should be
approached.) Too many times, mandates from ivory towers are used to
dictate standards of care. An example might be the practice of
performing an LP in a child who has had a febrile seizure. Some children
need it and some don't. Armed with experience and astute clinical
acumen, many pediatricians realize that these rules are not based on
clinical fact. It has been my suspicion that they were formed to help
guide housestaff in their training. Certainly all three month olds, in
fact few three month olds with 101 temps, should need to have an LP.
Most should not even need blood cultures.  The combination of a benign
clinical appearance, reassuring CBC, and a nonfocal exam along with the
assurance of good follow-up is all that is needed the majority of the
time. Oral antibiotic therapy in such a situation is in my opinion not
indicated. I would bet that the organism identified on the third day is
probably a contaminant and that the cultures obtained in the ED will all
be negative.
Scott Nau
 
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