Nearly two decades in the making, the American Academy of Pediatrics (AAP) has published the Clinical Practice Guideline for the Evaluation and Management of Well-Appearing Febrile Infants 8-60 Days Old.


Infant Fever Overview

About 14 out of every 1,000 healthy infants born full term develop a fever during the ages 8 days to 60 days old. While most fevers do not lead to severe illness, it can be challenging to immediately identify the cause of a baby’s fever while avoiding unnecessary tests or hospitalizations. More than 10% of febrile infants are diagnosed with a urinary tract infection. The likelihood of a more invasive bacterial infection is much lower, with fewer than .05% of infants developing meningitis, the most serious infection. Some other infections in young infants include pneumonia, sepsis and gastroenteritis.

 

AAP Recommendations

In its clinical practice guideline, AAP addresses many questions raised in evaluating otherwise well-appearing infants between 8-60 days old who develop a fever at or above 100.4 degrees Fahrenheit (38 degrees Celsius). Based on a comprehensive review of evidence, recommendations are provided for 3 age groups: 8-21 days, 22-28 days, and 29-60 days of age. For each age grouping, seven key action statements are provided: four deal with evaluation (urine, blood culture, inflammatory markers, cerebrospinal fluid), one with initial treatment and two with further management (hospitalization vs. home; cessation of treatment). The guidelines provide a decision-making algorithm for each age group.

Evaluation and Management of Well-Appearing Febrile Infants 8-60 Days Old 

Febrile Infant CPG Trackable Improvement and Implementation Measures 


Quality Improvement Tools & Resources

The American Academy of Pediatrics seeks to support pediatricians and their care teams through quality improvement in support of the mission that "every child gets the right care every time." The resources below support evaluation of fever and sepsis in infants.

Reducing Variability in the Infant Sepsis Evaluation (REVISE): A National Quality Initiative

This Value in Inpatient Pediatrics (VIP) Network project was designed to standardize care for young infants presenting with fever.

Value in Inpatient Pediatrics (VIP) Network: Reducing Excessive Variability in Infant Sepsis Evaluation (REVISE) Change Package

This change package was created for a VIP Network project. The change package is designed for pediatric hospitalists interested in eliminating harm and waste caused by over utilization.

Febrile Infants Key Driver Diagram

This resource serves as a map or guide to quality improvement. Aims are usually identified with key drivers serving as the “what” you need to do and the secondary drivers or implementation tools/resources serving as the “how” you will achieve the desired change.

Resources for Families

Fever and Your Baby
Fever is a common concern for parents of infants. This article defines fever, identifies potential causes and describes when to call the pediatrician.

Get Involved

These AAP groups and resources can provide additional information on Infant Fever.

Podcasts and Voices Blogs

Learn what others are saying. Listen to our podcasts and read our blog posts.

Diagnosing Infant Fevers

Infants with fevers often get extensive tests and treatment to rule out serious infection. In this AAP Voices blog post, Dr. Anne Vanden Belt shares how to spot babies at risk of life-threatening sepsis.

Voices Blog

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May 3, 2018

Last Updated

08/24/2021

Source

American Academy of Pediatrics