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Care of the Febrile Infant: How to Be a Pro

Most clinicians were on target; some situations call for special caution.

The optimal approach to the febrile infant is a subject of much concern and controversy. Panels have formulated numerous guidelines based on clinical judgment and laboratory testing, but the data were derived, primarily, from patients seen in academic centers and emergency departments. Pantell and colleagues evaluated the accuracy of office-setting diagnoses of serious bacterial infections (SBIs) in infants.

Through the Pediatric Research in Office Setting (PROS) study group, data were collected on 3066 febrile infants (age, 3 months or younger; no comorbidity). The rate of SBI in these patients was similar to that seen in previous studies: Overall, 1.8% of patients had bacteremia, and 0.5% had meningitis; both infections were more common in the first month of life. Clinicians followed current clinical guidelines in 42% of episodes. They ordered fewer laboratory tests than called for but detected 61 of 63 episodes of SBI (97%) at the initial visit, a degree of accuracy similar to that achieved by following a guideline-based model. Six patients who had SBI were febrile only at home and afebrile at their first visit.

Comment: These PROS clinicians detected most cases of infant SBI in their practices, using clinical judgment and fewer blood tests. It is critical to note the study's limitations: There were few data on African-American, Hispanic, and inner-city infants; and it is unknown whether a select group of clinicians with the resources to collect data represents the whole pediatric community. We all must assess our practices as they relate to the community we serve. We should be particularly alert to the possibility of SBI in infants younger than 1 month old and in those who had fever documented only at home. Let's strive to be even better pros than the PROS!

— Peggy Sue Weintrub, MD

Published in Journal Watch Pediatrics and Adolescent Medicine April 12, 2004

Citation(s):

Pantell RH et al. Management and outcomes of care of fever in early infancy. JAMA 2004 Mar 10; 291:1203-12.

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