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Table 2 Clinical and laboratory findings of common low‐risk criteria. Adapted from [12]

From: Facing the ongoing challenge of the febrile young infant

 

Boston

Milwaukee

Philadelphia

Rochester

Age range

28–89 days

28–56 days

29–60 days

≤60 days

History

No immunizations or antimicrobials in prior 48 h

Not defined

Not defined

Term infant; no prior antibiotics; no underlying disease; no hospitalization longer than mother

Physical exam

Well appearing; no signs of focal infection

Well appearing; no signs of focal infection

Well appearing; no signs of focal infection

Well appearing; no signs of focal infection

Laboratory parameters

CSF < 10 WBC/mm3

WBC < 20,000 mm3

UA < 10 WBC/hpf

CXR without infiltrate (if obtained)

CSF < 10/mm3

WBC < 15,000/mm3

UA < 5–10 WBC/hpf; UA no bacteria, negative leukocyte esterase, negative nitrites

CXR without infiltrate

CSF < 8 WBC/mm3

WBC < 15,000/mm3

UA < 10 WBC/hpf

CXR without infiltrate (if obtained)

WBC > 5000 and < 15,000/mm3

ABC < 1500/mm3

UA ≤ 10 WBC/hpf

CXR without infiltrate (if obtained)

Stool: WBC ≤ 5/hpf smear (if indicated)

Management strategies for high risk

Hospitalize, empiric antibiotics

Not defined

Hospitalize, empiric antibiotics

Hospitalize, empiric antibiotics

Management strategy for low risk

Home/outpatient ok

Empiric antibiotics, outpatient follow up required

Home/outpatient ok

i.m. ceftriaxone 50 mg/kg followed by outpatient follow up within 24 h

Must have reliable caretaker

Home/outpatient ok

No antibiotics, but outpatient follow up is required

Home/outpatient ok

No antibiotics, but outpatient follow up is required

  1. CXR chest X‐ray, UA urinalysis, CSF cerebrospinal fluid, WBC white blood cells, ABC absolute band count, hpf high power field, i.m. intramuscular