{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,12]],"date-time":"2026-10-12T22:49:00Z","timestamp":1791845340337,"version":"4.3.4"},"reference-count":43,"publisher":"Frontiers Media SA","license":[{"start":{"date-parts":[[2024,11,1]],"date-time":"2024-11-01T00:00:00Z","timestamp":1730419200000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":["frontiersin.org"],"crossmark-restriction":true},"short-container-title":["Front. Pediatr."],"abstract":"<jats:sec><jats:title>Background<\/jats:title><jats:p>Fever is a common symptom in children, but despite existing guidelines, pediatricians may not fully apply recommendations. Fever of Unknown Origin (FUO) is generally referred to as an unexplained prolonged fever. However, a standardized FUO definition and management is missing.<\/jats:p><\/jats:sec><jats:sec><jats:title>Objective<\/jats:title><jats:p>To collect updated data on the approach to fever and FUO among Italian pediatricians.<\/jats:p><\/jats:sec><jats:sec><jats:title>Methods<\/jats:title><jats:p>A cross-sectional anonymous survey was conducted among a large sample of primary care and hospital pediatricians. The panel group formulated and proposed a practical FUO definition, using a modified Delphi approach. A 75% consensus was required to reach an agreement.<\/jats:p><\/jats:sec><jats:sec><jats:title>Results<\/jats:title><jats:p>Among 620 respondents, paracetamol was the first-choice antipyretic for 97.7% of participants, followed by ibuprofen; 38.4% prescribed antipyretics based on a specific body temperature rather than on child's discomfort, while physical methods were almost completely abandoned. Alternate treatment was recommended by 19.8% (123\/620) of participants, 16.9% (105\/620) would prescribe antipyretics to prevent adverse events following immunization. Regarding FUO diagnosis, 58.3% (362\/620) considered as cut-off a body temperature above 38\u00b0C; the duration required was one week according to 36.45% (226\/620) of participants, two weeks according to 35.32% (219\/620). The FUO definition proposed by the expert panel reached 81% of consent. Large agreement was observed on first-level laboratory and instrumental investigations in the diagnostic evaluation of FUO, whereas more discrepancies arose on second and third-level investigations. Compared to what participants reported for the treatment of non-prolonged fever, a significant decrease in the prescription of paracetamol as first-choice drug in children with FUO was observed (80.5%; <jats:italic>P<\/jats:italic>\u2009&amp;lt;\u20090.0001). Interestingly, 39% of participants would empirically recommend antibiotics, 13.7% steroids, and 4.5% Nonsteroidal Anti-Inflammatory Drugs (NSAIDs) for persistent FUO.<\/jats:p><\/jats:sec><jats:sec><jats:title>Conclusion<\/jats:title><jats:p>Non-recommended behaviors in fever management persist among pediatricians, including alternating use of paracetamol and ibuprofen, and their prophylactic use for vaccinations. Our data confirm the variability in the definition, work-up, and management of FUO. We observed that in children with FUO paracetamol was significantly less commonly preferred than in non-prolonged fever, which is not supported by evidence. Our findings combined with evidence from existing literature underlined the need for future consensus documents.<\/jats:p><\/jats:sec>","DOI":"10.3389\/fped.2024.1452226","type":"journal-article","created":{"date-parts":[[2024,11,1]],"date-time":"2024-11-01T04:34:15Z","timestamp":1730435655000},"update-policy":"https:\/\/doi.org\/10.3389\/crossmark-policy","source":"Crossref","is-referenced-by-count":9,"title":["Fever management in children and insights into fever of unknown origin: a survey among Italian pediatricians"],"prefix":"10.3389","volume":"12","author":[{"given":"Elena","family":"Chiappini","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Michela","family":"Orlandi","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Alberto","family":"Chiarugi","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Antonio","family":"Di 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