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Management of the Febrile Young Infant

Update for the 21st Century

Woll, Christopher MD*; Neuman, Mark I. MD, MPH; Aronson, Paul L. MD*

doi: 10.1097/PEC.0000000000001303
CME Review Article

Infants aged 90 days or younger with fever are frequently evaluated in the pediatric emergency department. Physical examination findings and individual laboratory investigations are not reliable to differentiate benign viral infections from serious bacterial infections in febrile infants. Clinical prediction models were developed more than 25 years ago and have high sensitivity but relatively low specificity to identify bacterial infections in febrile infants. Newer laboratory investigations such as C-reactive protein and procalcitonin have favorable test characteristics compared with traditional laboratory studies such as a white blood cell count. These novel biomarkers have not gained widespread acceptance because of lack of robust prospectively collected data, varying thresholds to define positivity, and differing inclusion criteria across studies. However, C-reactive protein and procalcitonin, when combined with other patient characteristics in the step-by-step approach, have a high sensitivity for detection of serious bacterial infection. The RNA biosignatures are a novel biomarker under investigation for detection of bacterial infection in febrile infants.

*Fellow (Woll), Assistant Professor (Aronson), Departments of Pediatrics and of Emergency Medicine, Section of Pediatric Emergency Medicine, Yale School of Medicine, New Haven, CT; and †Associate Professor (Neuman), Division of Emergency Medicine, Department of Pediatrics, Boston Children's Hospital, Harvard Medical School, Boston, MA.

The authors, faculty, and staff in a position to control the content of this CME activity and their spouses/life partners (if any) have disclosed that they have no financial relationships with, or financial interest in, any commercial organizations pertaining to this educational activity.

This study was supported by CTSA grant number KL2 TR001862 (P.A.) from the National Center for Advancing Translational Science (NCATS), a component of the National Institutes of Health (NIH).

The content is solely the responsibility of the authors and does not necessarily represent the official views of the NIH. Funding sources had no involvement in the writing of this report or the decision to submit this article for publication.

Reprints: Paul L. Aronson, MD, Section of Pediatric Emergency Medicine, Yale School of Medicine, 100 York St, Suite 1 F, New Haven, CT 06511 (e-mail:

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