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You are seeing a well-appearing 20 day old infant brought in for passing 4 stools instead of 6 today. The baby is full term, eating well, and there were no significant birth complications or maternal infections. Vital signs are rectal temperature 38.0 C, HR 140, RR 36, O2 sat 99% on room air. Physical exam is unremarkable except the right tympanic membrane is redder than the left.
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August 9, 2022 at 12:42 pm
A) Perform CBC, UA, LP, blood/urine/CSF cultures, and admit for empiric parenteral antibiotics
The recently released AAP guidelines for evaluating febrile 8-60 day olds endorses a full “rule-out sepsis” work-up in 8-21 days, including admission for empiric parenteral antibiotics. For those 22 days and older, it may be appropriate to screen with labs and inflammatory markers (procalcitonin, CRP) and then base additional work-up and therapy on the results. Ceftriaxone is not recommended in < 22 day olds due to its potential to displace bilirubin from binding sites. Bundling has not been shown to be a cause of fever when core temperatures are measured. Acute bacterial otitis media requires more than a red tympanic membrane for diagnosis. More on the AAP guidelines here http://pemsource.org/wp-content/uploads/2021/07/AAP-8-60-days-fever.pdf