Do the American Academy of Paediatrics Guidelines for Managing Febrile Infants Aged 22 to 28 Days Work for a Suburban Australian Emergency Department? A Retrospective Audit.

Abstract

Aim: The American Academy of Paediatrics (AAP) 2021 guideline on the management of febrile infants provides a separate algorithm for the 22- to 28-day-old infant. Provided a specific combination of inflammatory markers is in the low-risk range, lumbar puncture (LP) and empiric antibiotics are optional. The Australian guidelines recommend LP and empiric antibiotics in all febrile neonates (< 29 days). We describe the management of this age group over 8 years and review how using the AAP guideline would alter management.

Methods: A single-centre retrospective chart review was conducted at Sunshine Hospital, Melbourne. The medical records of 50 consecutive well-appearing febrile infants aged 22-28 days were reviewed. Data on investigations, antibiotics, and duration of hospital stay were compared to the AAP recommendations.

Results: Of the 45 patients who met the inclusion criteria, 31% had no LP and 18% were observed without antibiotics. In the setting of normal inflammatory markers, these proportions increased to 48% and 27% respectively. All infants with abnormal inflammatory markers received these interventions. Using the AAP algorithm, 51% of patients would have been eligible for observation without LP or antibiotics. Two cases of bacteraemia were identified, both with abnormal inflammatory markers. Most infants were observed for 48 h (77%), with smaller proportions observed for 36 h (16%) and 24 h (7%).

Conclusions: Clinicians frequently perform a more limited septic evaluation in 22- to 28-day-old infants when inflammatory markers are normal. A revised approach to fever in this age group could reduce unnecessary LP and antibiotic use by up to 50%.