[PDF] [PDF] CSW Neonatal Fever Pathway - Seattle Childrens

[PDF] Fever in Infants Less than 60 Days - Childrens Hospital Colorado

1 fév 2018 · ≤ 28 days old? or Clinical Suspicion of SBI? Full Sepsis Workup • CBC with diff or 

[PDF] Fever Without Source in Infants < 90 Days Care - CHOC Childrens

Inclusion Criteria: Previously healthy children 0-90 days of age who have: • Fever 38 0° C or greater In general, febrile infants

[PDF] CSW Neonatal Fever Pathway - Seattle Childrens

Neonatal Fever v6 0: ED Phase (0-28 days old) Explanation of Evidence significantly lower risk of SBIs than infants without RSV infection Purcell 2002: 2396 

[PDF] The Febrile Neonate and Young Infant

Well appearing neonate fever 38 7 at home, no fever in ED Generally 1 0 to 1 8 F lower than rectal temperature ▫ Pacifier - requires 3 to Febrile neonate- < 28 days old- risk SBI 10 ▫ Urinary Infants < 2 mths different than older child:

[PDF] Fever Without a Source Clinical Guideline - Dell Childrens Medical

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[PDF] 0-60 Days Old - Texas Childrens Hospital

All infants 0-60 days with fever without localizing signs should be tested for For enterovirus-positive infants 0-28 days old, they should have a minimum of 24 Definition and etiology of fever in neonates and infants (less than 3 months of 

[PDF] Clinical Practice Guidelines for Febrile Infants - UI Health Care - The

Infants with gestational age less than 37 weeks, with congenital medical and/or surgical Infants 60 days of age, or any infant without a fever either on exam or by history Management of Low Risk Febrile Infants 7 to 28 Days

[PDF] Fever in Infants 0-90 days old - Alaska Native Medical Center

Fever in Infants Less than 60 Days 2018 February Available from: ANMC Fever in Neonates 0-28 Days Old Guideline Full septic work-up: • CBC w/ diff

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Last Updated: May 2023

Next Expected Review: November 2027

For questions concerning this pathway, contact:

NeonatalFever@seattlechildrens.org

For questions concerning this pathway, contact:

NeonatalFever@seattlechildrens.org

© 2023 Seattle Childrens Hospital, all rights reserved

If you are a patient with questions contact your medical provider, Medical DisclaimerIf you are a patient with questions contact your medical provider, Medical Disclaimer

Stop and

Review

Inclusion Criteria

Fever C (or a reliable history of fever) or hypothermia < 36 C in children days of age

Exclusion Criteria

Patients currently admitted to ICU or admitted > 3 days

Known immunodeficiency or cancer

Patients with central venous catheters or VP shunts

Inclusion Criteria

Fever C (or a reliable history of fever) or hypothermia < 36 C in children days of age

Exclusion Criteria

Patients currently admitted to ICU or admitted > 3 days

Known immunodeficiency or cancer

Patients with central venous catheters or VP shunts Inpatient Phase 22-28 daysInpatient Phase 22-28 days Inpatient Phase 0-21 daysInpatient Phase 0-21 days

ED phase 22-60 days with

Bronchiolitis

ED phase 22-60 days with

Bronchiolitis

ED phase 29-60 daysED phase 29-60 days

ED phase 22-28 daysED phase 22-28 days

ED phase 0-21 daysED phase 0-21 days

Evidence RatingsEvidence RatingsApproval & CitationApproval & CitationVersion ChangesVersion Changes

Neonatal Fever Care

Appendix

BibliographyBibliography

Neonatal Fever Pathway v10.0: Table of Contents

Inpatient Phase 29-60 daysInpatient Phase 29-60 days

Last Updated: May 2023

Next Expected Review: November 2027

For questions concerning this pathway, contact:

NeonatalFever@seattlechildrens.org

For questions concerning this pathway, contact:

NeonatalFever@seattlechildrens.org

© 2023 Seattle Childrens Hospital, all rights reserved

If you are a patient with questions contact your medical provider, Medical DisclaimerIf you are a patient with questions contact your medical provider, Medical Disclaimer

Stop and

Review

Inclusion Criteria

Fever C (or a reliable history of fever) or hypothermia < 36 C in children days of age

Exclusion Criteria

Patients currently admitted to ICU or admitted > 3 days

Known immunodeficiency or cancer

Patients with central venous catheters or VP shunts

Inclusion Criteria

Fever C (or a reliable history of fever) or hypothermia < 36 C in children days of age

Exclusion Criteria

Patients currently admitted to ICU or admitted > 3 days

Known immunodeficiency or cancer

Patients with central venous catheters or VP shunts Neonatal Fever Pathway v10.0: ED Phase (0-21 days old)

Urgent Care Transfer Guidelines

(for 0-21 days)

Well appearing neonates with fever

transfer via POV to an ED.

Ill appearing neonates with fever:

Initiate transport immediately

Administer antibiotics (IV or IM)

Attempt to obtain labs (do not delay

transport for labs)

Other differential

diagnosis for severely ill neonates

Other differential

diagnosis for severely ill neonatesBegin clinical assessment

Focal Infection?

(e.g., omphalitis, pneumonia)

Focal Infection?

(e.g., omphalitis, pneumonia)

UA, urine culture

CBC with diff

Blood culture

CSF studies

HSV work up if indicated (see

box)

Consider CXR and respiratory

viral panel (if respiratory symptoms)

Consider Stool PCR (if

diarrhea)

Consider ammonia if ill or

septic appearing

UA, urine culture

CBC with diff

Blood culture

CSF studies

HSV work up if indicated (see

box)

Consider CXR and respiratory

viral panel (if respiratory symptoms)

Consider Stool PCR (if

diarrhea)

Consider ammonia if ill or

septic appearing

Begin empiric treatment

Ampicillin and ceftazidime

Acyclovir if HSV work up

performed

Admit all patients

Begin empiric treatment

Ampicillin and ceftazidime

Acyclovir if HSV work up

performed

Admit all patients

Phase Change

Go to Inpatient Phase (0-21d)

Phase Change

Go to Inpatient Phase (0-21d)

CSF Normative Values

0-1 month: CSF WBC < 20/mm3

>I month: CSF WBC < 10/mm3

CSF Normative Values

0-1 month: CSF WBC < 20/mm3

>I month: CSF WBC < 10/mm3

Inability to obtain

CSF in ED

Inability to obtain

CSF in ED

If CSF

pleocytosis consider

CSF Rapid Viral Qual.

PCR

If CSF

pleocytosis consider

CSF Rapid Viral Qual.

PCR

Off PathwayYes

No

HSV work up indications

Perform complete work up and begin

acyclovir for any of the following:

Historical and clinical features

severe illness hypothermia lethargy seizures hepatosplenomegaly postnatal HSV contact vesicular rash conjunctivitis interstitial pneumonitis

Laboratory features

thrombocytopenia

CSF pleocytosis > 20 WBC/mm3

without clear bacterial infection (e.g., + Gram stain)

HSV work up indications

Perform complete work up and begin

acyclovir for any of the following:

Historical and clinical features

severe illness hypothermia lethargy seizures hepatosplenomegaly postnatal HSV contact vesicular rash conjunctivitis interstitial pneumonitis

Laboratory features

thrombocytopenia

CSF pleocytosis > 20 WBC/mm3

without clear bacterial infection (e.g., + Gram stain)

In well-appearing

infants with multiple maternal HSV risk factors, consider HSV work up

In well-appearing

infants with multiple maternal HSV risk factors, consider HSV work up

Last Updated: May 2023

Next Expected Review: November 2027© 2023 Seattle Childrens Hospital, all rights reserved

For questions concerning this pathway, contact:

Neonatalfever@seattlechildrens.org

For questions concerning this pathway, contact:

Neonatalfever@seattlechildrens.org

If you are a patient with questions contact your medical provider, Medical DisclaimerIf you are a patient with questions contact your medical provider, Medical Disclaimer

Neonatal Fever Pathway v10.0: ED Phase (22-28 days old)

Stop and

Review

Inclusion Criteria

Fever C (or a reliable history of fever) or hypothermia < 36 C in children 22-28 days of age

Exclusion Criteria

Patients currently admitted to ICU or admitted > 3 days

Known immunodeficiency or cancer

Patients with central venous catheters or VP shunts

Inclusion Criteria

Fever C (or a reliable history of fever) or hypothermia < 36 C in children 22-28 days of age

Exclusion Criteria

Patients currently admitted to ICU or admitted > 3 days

Known immunodeficiency or cancer

Patients with central venous catheters or VP shunts

Urgent Care Transfer

Guidelines (for 22-28

days)

Well appearing neonate:

Transfer to the ED if

abnormal inflammatory markers (ANC, CRP,

Procalcitonin) or if

unable to obtain inflammatory markers

Ill appearing neonates with

fever:

Initiate transport

immediately

Administer antibiotics

(IV or IM)

Attempt to obtain labs

(do not delay transport for labs)

If CSF

pleocytosis consider

CSF Rapid Viral Qual.

PCR

If CSF

pleocytosis consider

CSF Rapid Viral Qual.

PCR

Focal Infection?

(e.g., omphalitis, pneumonia)

Focal Infection?

(e.g., omphalitis, pneumonia)

Gestational age < 37

weeks?

Gestational age < 37

weeks?

Bronchiolitis?

(increased work of breathing, cough, tachypnea, wheezing)

YesPhase Change

Go to ED Phase

(0-21d)

Phase Change

Go to ED Phase

(0-21d)

YesOff Pathway

Yes

Phase Change

Consider ED

Phase (22-60d) W/

Bronchiolitis

Phase Change

Consider ED

Phase (22-60d) W/

Bronchiolitis

Abnormal Inflammatory

Markers

ANC > 4000/mm3

CRP > 2.0 mg/dL

Procalcitonin > 0.5 ng/mL

Abnormal Inflammatory

Markers

ANC > 4000/mm3

CRP > 2.0 mg/dL

Procalcitonin > 0.5 ng/mL

CBC with diff

Blood culture

UA, urine culture

Procalcitonin or CRP if PCT

unavailable

Consider CXR and respiratory

viral panel (if respiratory symptoms)

Consider Stool PCR (if

diarrhea) No No

Ceftriaxone

contraindicated with hyperbilirubinemia

Abnormal inflammatory

markers or ill appearing?

Abnormal inflammatory

markers or ill appearing? NoYes

Shared decision making to

perform LP for CSF studies

Shared decision making to

perform LP for CSF studies

Perform LP for CSF studies

LP performed?CSF pleocytosis?

Administer ceftriaxone

Consider HSV workup if CSF

pleocytosis with negative gram stain and give acyclovir Admit

Admit for observation

May administer antibiotics

per shared decision making

Admit for observation

May administer antibiotics

per shared decision making

Will observation occur at

home?

Will observation occur at

home?

Administer ceftriaxone

Must have follow-up within 24 hours scheduled with

PCP or SCH urgent care

No Yes Yes No No

CSF Normative

Values

0-1 month: CSF WBC

< 20/mm3 >I month: CSF WBC < 10/mm3

CSF Normative

Values

0-1 month: CSF WBC

< 20/mm3 >I month: CSF WBC < 10/mm3

Phase Change

Inpatient Phase 22-28 days

Phase Change

Inpatient Phase 22-28 days

Other differential

diagnosis for severely ill neonates.

Other differential

diagnosis for severely ill neonates.

HSV work up

indications

Perform complete work

up and begin acyclovir for any of the following:

Historical and clinical

features severe illness hypothermia lethargy seizures hepatosplenomegaly postnatal HSV contact vesicular rash conjunctivitis interstitial pneumonitis

Laboratory features

thrombocytopenia

CSF pleocytosis > 20

WBC/mm3 without

clear bacterial infection (e.g., + Gramquotesdbs_dbs21.pdfusesText_27