• emergency care
• infectious disease medicine
• sepsis

Identifying children with serious bacterial infection (SBI) can be challenging. To aid clinicians in the UK and Ireland, the National Institute for Health and Care Excellence (NICE) provides guidance on those children at greatest risk via NICE guideline (NG51) Sepsis: recognition, diagnosis and early management. One of those ‘high risk’ groups are infants under 3 months of age presenting with a fever or history of fever over 38°C. For this high-risk group, NICE NG51 recommends extensive investigation and administration of broad-spectrum antibiotics to all within the hour.1 Internationally, however, approaches differ. In the USA and Europe, validated clinical decision tools have been developed.2 3 These tools allow for a tailored approach that reduces the need for painful interventions such as lumbar puncture, improves antimicrobial stewardship and reduces the need for hospital admission.2 3

Although approaches to assessment and management vary internationally, there are some areas where we do agree. The rates of serious bacterial infections are similar in the UK, Europe and the USA with between 10% and 20% of febrile young infants having a serious bacterial infection,2–4 the majority of which (9%–17%) will be urinary tract infections and (1%–3%) will be invasive bacterial infections such as meningitis and bacterial sepsis.2–4 We all agree that younger infants under 28 days of age are at higher risk for serious bacterial infections and finally we all agree that no pattern of clinical features or exam findings can be used to …