{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,11,10]],"date-time":"2026-11-10T12:24:07Z","timestamp":1794313447275,"version":"4.9.0"},"reference-count":34,"publisher":"BMJ","issue":"3","content-domain":{"domain":["bmj.com"],"crossmark-restriction":true},"short-container-title":["Arch Dis Child"],"published-print":{"date-parts":[[2017,3]]},"abstract":"<jats:sec><jats:title>Objective<\/jats:title><jats:p>To analyse the outpatient management of selected febrile infants younger than 90\u2005days without systematic lumbar puncture and antibiotics.<\/jats:p><\/jats:sec><jats:sec><jats:title>Methods<\/jats:title><jats:p>A prospective registry-based cohort study including all the infants \u226490\u2005days with fever without a source (FWS) who were evaluated in a paediatric emergency department (ED) over a 7-year period (September 2007\u2013August 2014). We analysed the outcome of those infants with low-risk criteria for serious bacterial infection (SBI) managed as outpatients without antibiotics and without undergoing a lumbar puncture. Low-risk criteria: Well appearing, older than 21\u2005days of age, no leucocyturia, absolute neutrophil count \u226410\u2005000, serum C reactive protein \u226420\u2005mg\/L, procalcitonin &lt;0.5\u2005ng\/mL and no clinical deterioration during the stay in the ED (always &lt;24\u2005hours).<\/jats:p><\/jats:sec><jats:sec><jats:title>Results<\/jats:title><jats:p>1472 infants with FWS attended the ED. Of these, 676 were classified to be at low risk for SBI without performing a lumbar puncture. After staying &lt;24\u2005hours in the short-stay unit of the ED, 586 (86.6%) were managed as outpatients without antibiotics. Two patients were diagnosed with SBI: one occult bacteraemia and one bacterial gastroenteritis. Both were afebrile when evaluated again and did well. No patient returned to the ED due to clinical deterioration. Fifty-one infants (8.7%) returned to the ED mainly due to persistence of fever or irritability. None was diagnosed with definite SBI or non-bacterial meningitis.<\/jats:p><\/jats:sec><jats:sec><jats:title>Conclusions<\/jats:title><jats:p>Outpatient management without antibiotics and systematic lumbar puncture is appropriate for selected febrile infants younger than 3\u2005months of age with close follow-up.<\/jats:p><\/jats:sec>","DOI":"10.1136\/archdischild-2016-310600","type":"journal-article","created":{"date-parts":[[2016,7,29]],"date-time":"2016-07-29T02:48:42Z","timestamp":1469760522000},"page":"244-249","update-policy":"https:\/\/doi.org\/10.1136\/crossmarkpolicy","source":"Crossref","is-referenced-by-count":27,"title":["Outpatient management of selected young febrile infants without antibiotics"],"prefix":"10.1136","volume":"102","author":[{"given":"Santiago","family":"Mintegi","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Borja","family":"Gomez","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Lidia","family":"Martinez-Virumbrales","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Oihane","family":"Morientes","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Javier","family":"Benito","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"239","published-online":{"date-parts":[[2016,7,28]]},"reference":[{"key":"key-10.1136\/archdischild-2016-310600-1","doi-asserted-by":"crossref","first-page":"5","DOI":"10.1016\/j.cpem.2003.11.008","article-title":"Update on the management of the febrile infant","volume":"5","author":"Harper","year":"2004","journal-title":"Clin Pediatr Emerg Med"},{"key":"key-10.1136\/archdischild-2016-310600-2","doi-asserted-by":"crossref","first-page":"530","DOI":"10.1067\/S0196-0644(03)00628-0","article-title":"Clinical policy for children younger than three years presenting to the Emergency Department with fever","volume":"42","author":"ACEP Clinical Policies Committee and the Clinical Policies Subcommittee on Pediatric Fever","year":"2003","journal-title":"Ann Emerg Med"},{"key":"key-10.1136\/archdischild-2016-310600-3","doi-asserted-by":"crossref","first-page":"167","DOI":"10.1016\/j.pcl.2005.09.012","article-title":"Fever without source in children 0 to 36 months of age","volume":"53","author":"Ishimine","year":"2006","journal-title":"Pediatr Clin North Am"},{"key":"key-10.1136\/archdischild-2016-310600-4","doi-asserted-by":"crossref","first-page":"667","DOI":"10.1542\/peds.2014-1382","article-title":"Variation in care of the febrile young infant <90 days in US pediatric emergency departments","volume":"134","author":"Aronson","year":"2014","journal-title":"Pediatrics"},{"key":"key-10.1136\/archdischild-2016-310600-5","doi-asserted-by":"crossref","first-page":"455","DOI":"10.1097\/INF.0b013e318247b9f2","article-title":"Is 15 days an appropriate cut-Off age for considering serious bacterial infection in the management of febrile infants?","volume":"31","author":"Garcia","year":"2012","journal-title":"Pediatr Infect Dis J"},{"key":"key-10.1136\/archdischild-2016-310600-6","doi-asserted-by":"crossref","first-page":"287","DOI":"10.1136\/adc.2008.138768","article-title":"A week-by-week analysis of the low-risk criteria for serious bacterial infection in febrile neonates","volume":"94","author":"Schwartz","year":"2009","journal-title":"Arch Dis Child"},{"key":"key-10.1136\/archdischild-2016-310600-7","doi-asserted-by":"crossref","first-page":"1198","DOI":"10.1016\/S0196-0644(05)80991-6","article-title":"Practice guideline for the management of infants and children 0 to 36 months of age with fever without source. Agency for Health Care Policy and Research","volume":"22","author":"Baraff","year":"1993","journal-title":"Ann Emerg Med"},{"key":"key-10.1136\/archdischild-2016-310600-8","first-page":"1146","article-title":"Iatrogenic risks and financial costs of hospitalizing febrile infants","volume":"137","author":"DeAngelis","year":"1983","journal-title":"Am J Dis Child"},{"key":"key-10.1136\/archdischild-2016-310600-9","doi-asserted-by":"crossref","first-page":"1135","DOI":"10.1542\/peds.89.6.1135","article-title":"Clinical and cost-effectiveness of outpatient strategies for management of febrile infants","volume":"89","author":"Lieu","year":"1992","journal-title":"Pediatrics"},{"key":"key-10.1136\/archdischild-2016-310600-10","doi-asserted-by":"crossref","first-page":"228","DOI":"10.1542\/peds.2009-1070","article-title":"Performance of low-risk criteria in the evaluation of young infants with fever: review of the literature","volume":"125","author":"Huppler","year":"2010","journal-title":"Pediatrics"},{"key":"key-10.1136\/archdischild-2016-310600-11","doi-asserted-by":"crossref","first-page":"1437","DOI":"10.1056\/NEJM199311113292001","article-title":"Outpatient management without antibiotics of fever in selected infants","volume":"329","author":"Baker","year":"1993","journal-title":"N Engl J Med"},{"key":"key-10.1136\/archdischild-2016-310600-12","doi-asserted-by":"crossref","first-page":"355","DOI":"10.1016\/S0022-3476(88)80312-3","article-title":"Ambulatory care of febrile infants younger than 2 months of age classified as being at low risk for having serious bacterial infections","volume":"112","author":"Dagan","year":"1988","journal-title":"J Pediatr"},{"key":"key-10.1136\/archdischild-2016-310600-13","unstructured":"Feverish illness in children overview. Nice Pathways. Pathway last updated: 08 December 2015. http:\/\/pathways.nice.org.uk\/pathways\/feverish-illness-in-children. Last visited, 2016-01-28."},{"key":"key-10.1136\/archdischild-2016-310600-14","doi-asserted-by":"crossref","first-page":"673","DOI":"10.3928\/00904481-20081001-01","article-title":"Management of infants and young children with fever without source","volume":"37","author":"Baraff","year":"2008","journal-title":"Pediatr Ann"},{"key":"key-10.1136\/archdischild-2016-310600-15","doi-asserted-by":"crossref","first-page":"167","DOI":"10.1097\/MEJ.0b013e3283307af9","article-title":"Well appearing young infants with fever without known source in the Emergency Department: are lumbar punctures always necessary?","volume":"17","author":"Mintegi","year":"2010","journal-title":"Eur J Emerg Med"},{"key":"key-10.1136\/archdischild-2016-310600-16","doi-asserted-by":"crossref","first-page":"43","DOI":"10.1097\/INF.0b013e3181c6dd14","article-title":"Blood culture and bacteremia predictors in infants less than three months of age with fever without source","volume":"29","author":"G\u00f3mez","year":"2010","journal-title":"Pediatr Infect Dis J"},{"key":"key-10.1136\/archdischild-2016-310600-17","doi-asserted-by":"crossref","first-page":"595","DOI":"10.1097\/INF.0000000000000225","article-title":"The changing epidemiology of serious bacterial infections in young infants","volume":"33","author":"Greenhow","year":"2014","journal-title":"Pediatr Infect Dis J"},{"key":"key-10.1136\/archdischild-2016-310600-18","doi-asserted-by":"crossref","first-page":"815","DOI":"10.1542\/peds.2011-3575","article-title":"Diagnostic value of procalcitonin in well-appearing young febrile infants","volume":"130","author":"Gomez","year":"2012","journal-title":"Pediatrics"},{"key":"key-10.1136\/archdischild-2016-310600-19","doi-asserted-by":"crossref","first-page":"968","DOI":"10.1136\/adc.2009.176800","article-title":"Validation of a laboratory risk index score for the identification of severe bacterial infection in children with fever without source","volume":"95","author":"Galetto-Lacour","year":"2010","journal-title":"Arch Dis Child"},{"key":"key-10.1136\/archdischild-2016-310600-20","doi-asserted-by":"crossref","first-page":"e19","DOI":"10.1136\/emermed-2013-202449","article-title":"Accuracy of a sequential approach to identify young febrile infants at low risk for invasive bacterial infection","volume":"31","author":"Mintegi","year":"2014","journal-title":"Emerg Med J"},{"key":"key-10.1136\/archdischild-2016-310600-21","doi-asserted-by":"crossref","first-page":"e20154381","DOI":"10.1542\/peds.2015-4381","article-title":"Validation of the \u201cStep by Step\u201d approach in the management of young febrile infants","volume":"138","author":"Gomez","year":"2016","journal-title":"Pediatrics"},{"key":"key-10.1136\/archdischild-2016-310600-22","doi-asserted-by":"crossref","first-page":"312","DOI":"10.1097\/PEC.0b013e3181d6db37","article-title":"The pediatric assessment triangle: a novel approach for the rapid evaluation of children","volume":"26","author":"Dieckmann","year":"2010","journal-title":"Pediatr Emerg Care"},{"key":"key-10.1136\/archdischild-2016-310600-23","doi-asserted-by":"crossref","first-page":"627","DOI":"10.1542\/peds.103.3.627","article-title":"The efficacy of routine outpatient management without antibiotics of fever in selected infants","volume":"103","author":"Baker","year":"1999","journal-title":"Pediatrics"},{"key":"key-10.1136\/archdischild-2016-310600-24","doi-asserted-by":"crossref","first-page":"22","DOI":"10.1016\/S0022-3476(05)80591-8","article-title":"Outpatient treatment of febrile infants 28 to 89 days of age with intramuscular administration of ceftriaxone","volume":"120","author":"Baskin","year":"1992","journal-title":"J Pediatr"},{"key":"key-10.1136\/archdischild-2016-310600-25","doi-asserted-by":"crossref","first-page":"390","DOI":"10.1542\/peds.94.3.390","article-title":"Febrile infants at low risk for serious bacterial infection an appraisal of the Rochester criteria and implications for management. Febrile Infant Collaborative Study Group","volume":"94","author":"Jaskiewicz","year":"1994","journal-title":"Pediatrics"},{"key":"key-10.1136\/archdischild-2016-310600-26","doi-asserted-by":"crossref","first-page":"494","DOI":"10.1097\/INF.0000000000000629","article-title":"Prevalence and predictors of bacterial meningitis in young infants with fever without a source","volume":"34","author":"Martinez","year":"2015","journal-title":"Pediatr Infect Dis J"},{"key":"key-10.1136\/archdischild-2016-310600-27","doi-asserted-by":"crossref","first-page":"518","DOI":"10.1097\/PEC.0b013e3182587d47","article-title":"Clinical and analytical characteristics and short-term evolution of enteroviral meningitis in young infants presenting with fever without source","volume":"28","author":"Gomez","year":"2012","journal-title":"Pediatr Emerg Care"},{"key":"key-10.1136\/archdischild-2016-310600-28","doi-asserted-by":"crossref","first-page":"77","DOI":"10.1097\/PEC.0b013e3181ce2fad","article-title":"Lack of cerebrospinal fluid pleocytosis in young infants with enterovirus infections of the central nervous system","volume":"26","author":"Seiden","year":"2010","journal-title":"Pediatr Emerg Care"},{"key":"key-10.1136\/archdischild-2016-310600-29","doi-asserted-by":"crossref","first-page":"874","DOI":"10.1136\/archdischild-2012-301884","article-title":"Enteroviral meningitis without pleocytosis in children","volume":"97","author":"Yun","year":"2012","journal-title":"Arch Dis Child"},{"key":"key-10.1136\/archdischild-2016-310600-30","doi-asserted-by":"crossref","first-page":"1103","DOI":"10.1097\/INF.0b013e31822cbb5f","article-title":"Use of urine dipstick evaluating young infants with fever without a source and positive urine culture","volume":"30","author":"Mintegi","year":"2011","journal-title":"Pediatr Infect Dis J"},{"key":"key-10.1136\/archdischild-2016-310600-31","doi-asserted-by":"crossref","first-page":"e39","DOI":"10.1111\/apa.12789","article-title":"Using a urine dipstick to identify a positive urine culture in young febrile infants is as effective as in older patients","volume":"104","author":"Velasco","year":"2015","journal-title":"Acta Paediatr"},{"key":"key-10.1136\/archdischild-2016-310600-32","doi-asserted-by":"crossref","first-page":"e1121","DOI":"10.1542\/peds.2013-3291","article-title":"Dipstick screening for urinary tract infection in febrile infants","volume":"133","author":"Glissmeyer","year":"2014","journal-title":"Pediatrics"},{"key":"key-10.1136\/archdischild-2016-310600-33","doi-asserted-by":"crossref","first-page":"e12448","DOI":"10.1371\/journal.pone.0012448","article-title":"Changing epidemiology of serious bacterial infections in febrile infants without localizing signs","volume":"5","author":"Watt","year":"2010","journal-title":"PLoS ONE"},{"issue":"(Pt 1)","key":"key-10.1136\/archdischild-2016-310600-34","doi-asserted-by":"crossref","first-page":"964","DOI":"10.1542\/peds.111.5.964","article-title":"Serious bacterial infections in febrile infants younger than 90 days of age: the importance of ampicillin-resistant pathogens","volume":"111","author":"Byington","year":"2003","journal-title":"Pediatrics"}],"container-title":["Archives of Disease in Childhood"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/syndication.highwire.org\/content\/doi\/10.1136\/archdischild-2016-310600","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2022,7,4]],"date-time":"2022-07-04T05:03:13Z","timestamp":1656910993000},"score":1,"resource":{"primary":{"URL":"https:\/\/adc.bmj.com\/lookup\/doi\/10.1136\/archdischild-2016-310600"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2016,7,28]]},"references-count":34,"journal-issue":{"issue":"3","published-online":{"date-parts":[[2017,2,17]]},"published-print":{"date-parts":[[2017,3]]}},"alternative-id":["10.1136\/archdischild-2016-310600"],"URL":"https:\/\/doi.org\/10.1136\/archdischild-2016-310600","relation":{},"ISSN":["0003-9888","1468-2044"],"issn-type":[{"value":"0003-9888","type":"print"},{"value":"1468-2044","type":"electronic"}],"subject":[],"published":{"date-parts":[[2016,7,28]]}}}