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Evaluation and management of the well-appearing febrile infant 8 to 21 days of age

Evaluation and management of the well-appearing febrile infant 8 to 21 days of age
2021 American Academy of Pediatrics Clinical Practice Guideline: Algorithm for 8- to 21-day-old infants.

LP: lumbar puncture; HSV: herpes simplex virus; CRP: C-reactive protein; ANC: absolute neutrophil count; CSF: cerebrospinal fluid; PCR: polymerase chain reaction; IMs: inflammatory markers.

* Key action statement references are shown in parentheses. To see the statements, refer to the American Academy of Pediatrics Clinical Practice Guideline: Evaluation and management of well-appearing febrile infants 8 to 60 days old.
¶ Send CSF for cell count, Gram stain, glucose, protein, bacterial culture, and enterovirus PCR (if available) if pleocytosis is present and during periods of increased local enterovirus prevalence.
Δ Laboratory values of inflammation are considered elevated at the following levels: (1) procalcitonin >0.5 ng/mL, (2) CRP >20 mg/L, and (3) ANC >4000 to 5200 per mm3. Although we recommend all infants in this age group have a complete sepsis workup, receive parenteral antimicrobial agents, and be monitored in a hospital, knowing IM results can potentially guide ongoing clinical decisions.
HSV should be considered when there is a maternal history of genital HSV lesions or fevers from 48 hours before to 48 hours after delivery and in infants with vesicles, seizures, hypothermia, mucous membrane ulcers, CSF pleocytosis in the absence of a positive Gram stain result, leukopenia, thrombocytopenia, or elevated alanine aminotransferase levels. For further discussion, see the current Red Book. Recommended HSV studies are CSF PCR; HSV surface swabs of the mouth, nasopharynx, conjunctivae, and anus for an HSV culture (if available) or PCR assay; alanine aminotransferase; and blood PCR.

Reproduced with permission from Pediatrics, Vol. 148, Page e2021052228, Copyright © 2021 by the AAP.
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