Step-by-Step Approach to Febrile Infants
Validated clinical algorithm for risk stratification of febrile infants 1-90 days old to identify those with invasive bacterial infection (IBI). Stratifies into low, intermediate, and high risk groups to guide investigation and management.
Score interpretation
Step-by-Step low risk criteria met. Risk of IBI < 1.5%.
→ Well appearing infants > 21 days with normal inflammatory markers and urinalysis: can be managed without lumbar puncture. Close outpatient follow-up with reassessment. Consider discharge with safety net advice.
Intermediate risk. Some elevated markers but not high risk.
→ Full septic screen including blood cultures and LP (age-dependent). IV antibiotics pending cultures. Admit for observation. Paediatric review.
High risk for IBI. Ill appearance, very young age, or significantly elevated inflammatory markers.
→ Full septic workup: blood culture, LP, urine culture, CXR. IV antibiotics immediately (ceftriaxone +/- ampicillin for age <28 days). Admit to paediatric ward or PICU. Neonates <21 days: always high risk.
Interpretation bands for the Step-by-Step Febrile. Apply clinical judgement and local guidance.
References
- Gomez B, et al. Validation of the 'Step-by-Step' Approach in the Management of Young Febrile Infants. Pediatrics. 2016;138(2):e20154381.
- Mintegi S, et al. Accuracy of a sequential approach to identify young febrile infants at low risk for invasive bacterial infection. Emerg Med J. 2014;31:e11.
Related
Curated clinical cross-links plus same-class fallbacks.
- Gentamicin (Paediatric) · Aminoglycoside — Neonatal Sepsis / Gram-Negative Infections in Children
- Phenobarbital (Paediatric Epilepsy — Beyond Neonatal) · Barbiturate Anticonvulsant
- Diazepam (Paediatric) · Benzodiazepine — Status Epilepticus / Febrile Convulsions (Community)
- Dexamethasone (Paediatric) · Corticosteroid — Croup / Bacterial Meningitis / Post-Extubation Stridor / Cerebral Oedema
- Ceftriaxone (Paediatric) · Third-Generation Cephalosporin — Meningitis / Sepsis / Community-Acquired Pneumonia
- Aciclovir (Paediatric) · Antiviral — HSV Encephalitis / Neonatal Herpes / VZV in Immunocompromised
Decision support only — verify against a current formulary, NICE, or your local guideline before clinical use.