Evaluation of the febrile infant younger than 3 months of age with no source of infection

Because of the subtlety of their localizing signs, relative immunologic immaturity, and increased risk of SBI, young infants with fever traditionally have been admitted to the hospital. Recent literature indicates that the outpatient management of a select low-risk subset of these febrile infants between the ages of 28 and 90 days who meet appropriate screening criteria is possible with good follow-up care. Baker et al indicate that a lumbar puncture is warranted as part of the screening criteria for outpatient management in the 28-to-60-day age group.10 Until further large prospective studies are available, use of the Rochester criteria including lumbar puncture has been shown to provide the best screening method for selecting a low risk subset of febrile infants between the ages of 28 and 60 days who may be managed as outpatients. Management of infants between 60 and 90 days of age may be based on the Rochester screening criteria. Current studies that are ongoing may eventually define a similar subset of infants younger than 28 days of age who may be managed as outpatients. However, at the present time, management as an outpatient of low-risk infants younger than 28 days has not been recommended.3,10,11