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Neonatal fever - Initial Assessment

  • Definition = temperature > 38.0°C or 100.4°F
  • All febrile infants up to age 56 days undergo a sepsis workup:
    • CBC, blood culture
    • Urinalysis, urine culture
    • Lumbar puncture with cell count, Gram stain, glucose, protein, culture, +/- HSV PCR
    • Chest X-ray if respiratory distress
  • Age 0-4 wks
    • ADMISSION and IV antibiotics, regardless of physical exam, for 48h
    • If LP negative: ampicillin, gentamicin, +/- acyclovir
    • If LP positive: ampicillin, cefotaxime, +/- acyclovir
  • Age 4-8 wks
    • If well-appearing with normal exam and unremarkable labs, discharge home with antibiotics and CLOSE PMD FOLLOW-UP
    • If ill-appearing, concern based on exam findings, or positive labs*, admit and treat with vancomycin and cefotaxime
      • *Positive labs are defined as:
        CBC has WBC > 15,000 or <> 0.2
        LP shows CSF pleiocytosis
        Urinalysis > 10 WBCs
        Positive CXR findings

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