by Jason Woods (EM) and Abbey Nerlinger (HM), Children’s National

Febrile Infant take home points:
– There is large ED inter-hospital variation in care among febrile neonates/infants with minimal effect on hospital revisits and readmissions according to recent study in pediatrics
– Philadephia, Rochester, Boston criteria are more or less applicable depending on age of patient and whether or not CSF obtained
– hospitalist are considering discharge closer to 24 hours for well-appearing, low risk infants presenting with fever with good folllow up
– reduction in variation in care of neonatal fever has been shown to improve both quality and cost
– for infants < 28 days with missed LP consider admission and obs off antibiotics if well-appearing with unconcerning labs otherwise
– CSF wbc more reliable than Cx for pretreated LP
– consider ED instead of direct admit for infants with fever who may need urgent re-tap in the middle of the night; direct okay for pretreated if repeat LP nonurgent (ie, within 24 hours to look at pleocytosis)
– infants < 60 days with clinical picture c/w bronchiolitis (with or without RSV testing), consider admission off abx and observed without LP, or discharge home if > 1 month
– consider no LP for febrile infants > 28 days with UA concerning for UTI and well-appearing
– most effective future steps would be to ensure success of LPs through holder technique, resident competency, local anesthesia
– attempt to facilitate ED-hospitalist conversation regarding management in questionable situations