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