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Evaluation of the necessity for hospitalization of the febrile infant less than three months of age.
Pediatric Infectious Disease Journal 1990 March
We reviewed records of 443 consecutive infants less than 3 months of age who were hospitalized during a 28-month period for complete evaluation of fever (rectal temperature greater than or equal to 38 degrees C), close observation and consideration of antimicrobial therapy. Infants less than 2 weeks of age were more likely to be treated with parenterally administered antibiotics than older infants (67%, 39%, 29% and 31% in the first and second two weeks of life, second and third months, respectively), and were more likely to have bacteremia and bacterial meningitis (4.8%, 2.1%, 0.5% and 2.3%, respectively), as well as serious bacterial illness (25%, 13%, 7% and 14%, respectively). Five infants (2.5% of those not initially treated) had unexpectedly positive blood (1), urine (3) or stool (1) cultures and were treated with parenteral antibiotics when culture results were known. None was less than 2 weeks of age and all had good outcomes that did not appear to be altered by the delay in diagnosis and treatment. No infant's therapy was modified as a result of clinical deterioration or persistent fever. We conclude that many febrile infants who are hospitalized "for observation" can be managed as outpatients provided that a thorough initial evaluation is performed, that parents can reliably monitor the infant closely at home and that dependable follow-up can be assured.
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