{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,11,10]],"date-time":"2026-11-10T12:24:19Z","timestamp":1794313459189,"version":"4.9.0"},"reference-count":13,"publisher":"American Academy of Pediatrics (AAP)","issue":"1","content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":[],"published-print":{"date-parts":[[2023,1,1]]},"abstract":"<jats:sec>\n                  <jats:title\/>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>BACKGROUND AND OBJECTIVES<\/jats:title>\n                  <jats:p>In 2021, the American Academy of Pediatrics (AAP) published the Clinical Practice Guideline (CPG) for management of well-appearing, febrile infants 8 to 60 days old. For older infants, the guideline relies on several inflammatory markers, including tests not rapidly available in many settings like C-reactive protein (CRP) and procalcitonin (PCT). This study describes the performance of the AAP CPG for detecting invasive bacterial infections (IBI) without using CRP and PCT.<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>METHODS<\/jats:title>\n                  <jats:p>This retrospective cohort study included infants aged 8 to 60 days old presenting to Kaiser Permanente Northern California emergency departments between 2010 and 2019 with temperatures \u226538\u00b0C who met AAP CPG inclusion criteria and underwent complete blood counts, blood cultures, and urinalyses. Performance characteristics for detecting IBI were calculated for each age group.<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>RESULTS<\/jats:title>\n                  <jats:p>Among 1433 eligible infants, there were 57 (4.0%) bacteremia and 9 (0.6%) bacterial meningitis cases. Using absolute neutrophil count &amp;gt;5200\/mm3 and temperature &amp;gt;38.5\u00b0C as inflammatory markers, 3 (5%) infants with IBI were misidentified. Sensitivities and specificities for detecting infants with IBIs in each age group were: 8 to 21 days: 100% (95% confidence interval [CI] 83.9%\u2013100%) and 0% (95% CI 0%\u20131.4%); 22 to 28 days: 88.9% (95% CI 51.8%\u201399.7%) and 40.4% (95% CI 33.2%\u2013 48.1%); and 29 to 60 days: 93.3% (95% CI 77.9%\u201399.2%) and 32.1% (95% CI 29.1%\u2013 35.3%). Invasive interventions were recommended for 100% of infants aged 8 to 21 days; 58% to 100% of infants aged 22 to 28 days; and 0% to 69% of infants aged 29 to 60 days.<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>CONCLUSIONS<\/jats:title>\n                  <jats:p>When CRP and PCT are not available, the AAP CPG detected IBI in young, febrile infants with high sensitivity but low specificity.<\/jats:p>\n               <\/jats:sec>","DOI":"10.1542\/peds.2022-058495","type":"journal-article","created":{"date-parts":[[2022,12,7]],"date-time":"2022-12-07T08:06:45Z","timestamp":1670400405000},"source":"Crossref","is-referenced-by-count":15,"title":["Using AAP Guidelines for Managing Febrile Infants Without C-Reactive Protein and Procalcitonin"],"prefix":"10.1542","volume":"151","author":[{"given":"Tran H.P.","family":"Nguyen","sequence":"first","affiliation":[{"name":"aDepartment of Hospital Pediatrics, Kaiser Permanente Northern California, Roseville, California"},{"name":"cThe Permanente Medical Group, Oakland, California"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Beverly R.","family":"Young","sequence":"additional","affiliation":[{"name":"aDepartment of Hospital Pediatrics, Kaiser Permanente Northern California, Roseville, California"},{"name":"cThe Permanente Medical Group, Oakland, California"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Amy","family":"Alabaster","sequence":"additional","affiliation":[{"name":"bDivision of Research, Kaiser Permanente Northern California, Oakland, California"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"David R.","family":"Vinson","sequence":"additional","affiliation":[{"name":"bDivision of Research, Kaiser Permanente Northern California, Oakland, California"},{"name":"cThe Permanente Medical Group, Oakland, California"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Dustin G.","family":"Mark","sequence":"additional","affiliation":[{"name":"bDivision of Research, Kaiser Permanente Northern California, Oakland, California"},{"name":"cThe Permanente Medical Group, Oakland, California"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Patrick","family":"Van Winkle","sequence":"additional","affiliation":[{"name":"dDepartment of Pediatrics, Kaiser Permanente Southern California, Anaheim, California"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Adam L.","family":"Sharp","sequence":"additional","affiliation":[{"name":"eDepartment of Research and Evaluation"},{"name":"fBernard J. Tyson School of Medicine, Health Systems Science Department, Kaiser Permanente Southern California, Pasadena, California"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Judy","family":"Shan","sequence":"additional","affiliation":[{"name":"gSchool of Medicine, University of California at San Francisco, San Francisco, California"},{"name":"hDivision of Infectious Diseases, Department of Pediatrics, Kaiser Permanente Northern California, San Francisco, California"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Adina S.","family":"Rauchwerger","sequence":"additional","affiliation":[{"name":"bDivision of Research, Kaiser Permanente Northern California, Oakland, California"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Tara L.","family":"Greenhow","sequence":"additional","affiliation":[{"name":"cThe Permanente Medical Group, Oakland, California"},{"name":"hDivision of Infectious Diseases, Department of Pediatrics, Kaiser Permanente Northern California, San Francisco, California"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Dustin W.","family":"Ballard","sequence":"additional","affiliation":[{"name":"bDivision of Research, Kaiser Permanente Northern California, Oakland, California"},{"name":"cThe Permanente Medical Group, Oakland, California"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"417","published-online":{"date-parts":[[2022,12,7]]},"reference":[{"issue":"2","key":"2023111013541227300_B1","doi-asserted-by":"crossref","first-page":"e2021052228","DOI":"10.1542\/peds.2021-052228","article-title":"Evaluation and management of well-appearing febrile infants 8 to 60 days old","volume":"148","author":"Pantell","year":"2021","journal-title":"Pediatrics"},{"issue":"1","key":"2023111013541227300_B2","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 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