Evaluation and Management of Young Febrile Infants: An Overview of the New AAP Guideline

Abstract

The American Academy of Pediatrics released a clinical practice guideline for the management of febrile infants in August 2021 to compile nearly 40 years of research into a cohesive text that would provide a framework for the clinician in safely managing these patients in a variety of settings. (1) This guideline incorporates shared decision-making with the caregiver to guide treatment when appropriate and provides algorithms for 3 age groups: 8 to 21 days, 22 to 28 days, and 29 to 60 days. This guideline applies to previously healthy, well-appearing infants born at 37 weeks' gestation or later who have a temperature of at least 100.4°F (≥38.0°C) in the previous 24 hours at home or in a clinical setting. Infants younger than 8 days and those with diagnosed focal infections are excluded. The highlighted changes to historical practice are in the 2 older age groups. In 22- to 28-day-old infants, if initial laboratory work is normal, shared decision-making is used to direct lumbar puncture and hospital admission with the possibility of monitoring the patient at home or in the hospital. In 29- to 60-day-old infants, admission to the hospital is indicated only if laboratory evaluation is concerning for meningitis or based on clinician judgment. The occurrence of invasive bacterial infection in a febrile infant with a positive viral test is still not well-measured, as broad viral panels are more recently developed technology. As this research evolves and expected advancements in early detection of infectious organisms and biomarkers occur, this new information will need to be incorporated into the existing evidence.