Fever in infants under the age of two months

Fever in infants under the age of two months

The aim of this chapter is to briefly explain the rationale behind, and the different approaches to (including the most aggressive approach), the workup and treatment of infants under the age of two months with fever.
Guidelines for the workup of fever in infants under the age of three months have been previously published and have been recently revised by the American Academy of Pediatrics.

For more practical reasons, I have decided to dedicate this chapter for fever in infants under the age of two months. Infants above the age of two months can undergo ambulatory (outpatient) workup and do not necessarily have to be referred to the emergency department.

Why is it important to have guidelines specific for young infants with fever?

– The prevalence of bacterial infections in this population is higher than the general population (about 10% of infections are bacterial, now that’s a lot!)
– The ability of clinicians to distinguish between a simple viral infection and a severe bacterial infection in infants presenting with fever in this age group, is limited. Also, in this young age group, even minor signs such as a fever of 38 degrees Celsius (100.4 degrees Fahrenheit) and a decreased appetite, may indicate severe infection.

It is therefore common to refer all infants in this age group presenting with a fever of 38 degrees Celsius or above, to the emergency room, for a workup to be carried out according to the most recent (local) guidelines.

What is my personal recommendation with regards to infants aged one or two months with fever?

In my opinion, all infants under the age of one month with fever should visit the emergency department for a workup as soon as possible. There is no point in seeing the primary care physician or going through a primary care clinic. What kind of workup will these infants undergo at the emergency department? Read more about this here.
For infants between the age of one and two months – provided they are well-appearing (normal skin colour, no grunting, feeding well, do not look lethargic etc.) and are able to see their primary care physician promptly, then they may see their physician first. Some of the more conservative physicians will send all children in this age group with fever to the emergency room. Others will take a full history, carry out a physical examination and will decide upon the right management (which may or may not include a visit to the emergency room). If unable to see a pediatrician within timely manner, pay a visit to the emergency department.

A couple other important points to look out for in the age group – be aware that ibuprofen is not to be used in this age group. Acetaminophen is allowed.
The minimum interval between Acetaminophen doses is 5 hours, just as in other age groups.
Good luck!

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