Patient handout

Febrile infant (0-90 days)

PRODUCTION

1. Your condition

This handout is for febrile infant (0-90 days). Your care team identified this based on: fever ≥38°c (100.4°f) rectal in infant 0-90 days (aap 2021 pantell).

Other reasons your team may use this plan: ill-appearing neonate requiring immediate stabilization (aap 2021 pantell); maternal gbs colonization or chorioamnionitis with neonatal fever (aap 2021 pantell; cdc 2020 gbs).

2. Your medications

Take these medications exactly as prescribed. Do not stop or change a dose without talking to your provider.

Medication	Starting dose	How	When	What it does
ampicillin	50 mg/kg IV q8h (meningitis dose: 75-100 mg/kg IV q6h)	IV	q8h (q6h meningitis dosing)	Covers Listeria monocytogenes + enterococcus + GBS (AAP 2021 Pantell)
gentamicin	4-5 mg/kg IV q24h (term neonates)	IV	q24h	Synergistic gram-negative and GBS coverage (AAP 2021 Pantell; Neofax 2024)
acyclovir	20 mg/kg IV q8h	IV	q8h	HSV coverage mandatory when age ≤21d or clinical concern for neonatal HSV (Kimberlin Pediatrics 2013; AAP 2021 Pantell)

Plan: Febrile infant 0-28d — full empiric coverage (AAP 2021 Pantell + Kimberlin 2013)

4. When to seek emergency care

Call 911 or go to the nearest emergency room right away if you have:

Ill-appearing infant at any age 0-90d: lethargy, poor perfusion, mottled skin, weak cry, bulging fontanelle (AAP 2021 Pantell)(life-threatening)
HSV clinical features: vesicular lesions, seizures, CSF pleocytosis without bacteria, elevated AST/ALT, maternal HSV history, age ≤21d (Kimberlin Pediatrics 2013; AAP 2021 Pantell)(life-threatening)
CSF culture positive or CSF gram stain positive with compatible CSF profile (pleocytosis, elevated protein, low glucose) (AAP 2021 Pantell)(life-threatening)
ANC <1000/mcL in febrile infant 0-90d (AAP 2021 Pantell)
Hypotension for age, tachycardia with poor perfusion, delayed capillary refill >3 seconds in febrile infant (PALS 2020; AAP 2021 Pantell)(life-threatening)
Any rectal temperature ≥ 38.0 °C (100.4 °F) in an infant aged 0-7 days (AAP 2021 Pantell + neonatal-sepsis convention; below the 8-60 d AAP CPG window — defer to convention)(life-threatening)
Any of: procalcitonin > 0.5 ng/mL OR CRP > 20 mg/L OR WBC < 5 000 or > 15 000 /μL OR ANC ≥ 4 090 /μL (Step-by-Step Gomez Pediatrics 2016 PMID 27382134; AAP 2021 Pantell Section 6 + Table 4 cutoffs)

5. Follow-up

Discharge with reliable caregiver + 24h PCP follow-up if sent home on observation (AAP 2021 Pantell); return precautions for fever recurrence, poor feeding, lethargy, irritability; final culture check at 48-72h for all blood/urine/CSF cultures (AAP 2021 Pantell)

6. Sources

Guideline: AAP 2021 Clinical Practice Guideline for Febrile Infants 8-60d (Pantell Pediatrics 2021) + PECARN derivation (Kuppermann JAMA Pediatr 2019) + Step-by-Step (Gomez Pediatrics 2016) + Rochester criteria (Jaskiewicz Pediatrics 1994) + Philadelphia criteria (Baker Pediatrics 1993) + Boston criteria (Baskin J Pediatr 1992) + neonatal HSV (Kimberlin Pediatrics 2013)