Facing the ongoing challenge of the febrile young infant

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

	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

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

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