Objective To analyse the outpatient management of selected febrile infants younger than 90 days without systematic lumbar puncture and antibiotics.
Methods A prospective registry-based cohort study including all the infants ≤90 days with fever without a source (FWS) who were evaluated in a paediatric emergency department (ED) over a 7-year period (September 2007–August 2014). We analysed the outcome of those infants with low-risk criteria for serious bacterial infection (SBI) managed as outpatients without antibiotics and without undergoing a lumbar puncture. Low-risk criteria: Well appearing, older than 21 days of age, no leucocyturia, absolute neutrophil count ≤10 000, serum C reactive protein ≤20 mg/L, procalcitonin <0.5 ng/mL and no clinical deterioration during the stay in the ED (always <24 hours).
Results 1472 infants with FWS attended the ED. Of these, 676 were classified to be at low risk for SBI without performing a lumbar puncture. After staying <24 hours in the short-stay unit of the ED, 586 (86.6%) were managed as outpatients without antibiotics. Two patients were diagnosed with SBI: one occult bacteraemia and one bacterial gastroenteritis. Both were afebrile when evaluated again and did well. No patient returned to the ED due to clinical deterioration. Fifty-one infants (8.7%) returned to the ED mainly due to persistence of fever or irritability. None was diagnosed with definite SBI or non-bacterial meningitis.
Conclusions Outpatient management without antibiotics and systematic lumbar puncture is appropriate for selected febrile infants younger than 3 months of age with close follow-up.
- outpatient management
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Contributors SM conceptualised and designed the study, supervised data collection, analysed the data, wrote the initial draft of the manuscript and approved the final manuscript as submitted. BG collaborated in the design of the study and the data collection system, coordinated and supervised data collection, and reviewed and suggested revisions to the manuscript, and approved the final manuscript as submitted. LM-V and OM collaborated in the design of the study, were responsible for data collection, carried out the initial analyses and reviewed and suggested revisions to the manuscript, and approved the final manuscript as submitted. JB revised the design of the study and reviewed and suggested revisions to the manuscript, and approved the final manuscript as submitted.
Funding No external funding was secured for this study, including the following organisations: National Institutes of Health (NIH); Wellcome Trust; Howard Hughes Medical Institute (HHMI).
Competing interests None declared.
Patient consent Parental/guardian consent obtained.
Ethics approval Ethical Committee of the Cruces University Hospital.
Provenance and peer review Not commissioned; externally peer reviewed.