Introduction Parental concerns regarding fever are a common cause of Children’s Emergency attendances. As the cause of fever could be varied, most children are subjected to extensive workup and empirical antibiotic therapy.

Aim To evaluate the causes of fever and appropriateness of investigations and therapy in febrile neonates (post discharge) and infants presenting to a tertiary hospital in Singapore. To explore the possibility of a safe but pragmatic approach to management of these children.

Methods This retrospective study comprised of neonates (post-discharge), & children <1 year old, admitted to Paediatric medical wards at our hospital from January to December 2012. Data collected from Children’s Emergency (CE) records and Citrix data systems were analysed.

Results 216 children were included in the study, of whom 164 had documented temperatures above 37.6 C on admission. 52 children had reported fever before admission. Amongst the study children, 79 (36.5%) had full septic workup (blood, urine and CSF cultures) and 47 (22%) had partial septic workup (blood and urine cultures). Nasopharyngeal (NPA) swabs were done in 155 (76%) children. C – reactive protein (CRP) was tested in 163 (75%) and full blood count (FBC) in 166 (76%) of the cases. All blood and CSF cultures revealed negative results, and only 1 urine culture was positive in a patient with known history of E. Coli UTI. NPA detected viruses in 7 cases (5 Respiratory Syncytial Virus, 1 parainfluenza virus and 1 influenza virus). Antibiotics were empirically given to 116 (53.7%) children. There were no mortalities in the study group.

Conclusion & recommendations Amongst the children admitted with fever, only one (with previous history of E. Coli UTI) had proven bacterial infection. Hence, prudent evaluation and observation of well-looking children with selected initial investigations (such as FBC, CRP, UFEME) before extensive workup may help to limit investigations, reduce antibiotic usage, hospital stay and could ultimately be cost effective. Further randomised studies in well looking febrile children, rationalising investigations and antibiotic treatment could boost physician’s confidence and pave the way for a different safe and pragmatic approach, making it kinder to children and cost effective to parents / tax-payer.