Fever and Sepsis Evaluation in the Neonate (0-28 days)

Pathway Background and Objectives

Neonates presenting with fever are at high risk of having and/or developing a serious bacterial infection. In addition, neonates can present with extensive HSV disease. Early identification and management is critical for improved outcomes. The AAP released a new clinical practice guideline in 2021 for febrile infants aged 8-60 days old that are well-appearing. These recommendations were carefully reviewed by our CT Children’s stakeholders in Infectious Disease and Immunology, Pediatric Hospital Medicine, and the Emergency Department, and modified to meet the needs for our specific patient population.

The objectives of this pathway are to:

  • Standardize initial work-up for neonates presenting with fever/sepsis
  • Decrease unnecessary variation in patient care based on current evidence
  • Provide guidelines for when to include HSV testing/treatment
  • Help guide appropriate antimicrobial therapy
  • Provide guidelines for a safe discharge home

Algorithm  Educational Module

  • % Patients with pathway order set
  • % HSV testing performed as indicated by pathway
  • % of patients with appropriate first line antibiotics received, per pathway
  • % of patients with normal testing that have antibiotics discontinued within 48-50 hours
  • % of patients with CSF studies completed, or not completed, per pathway
  • # of ED returns within 72 hours of discharge
  • ALOS (inpatient, days)
  • Pathway bundle: % patients with antibiotics received, as indicated by pathway (correct med and correct dosage), % of patients with antibiotic administration within 2 hours of CSF collection time
  • Jain, et al. Management of Febrile Neonates in the US Pediatric Emergency Departments. 2014. Pediatrics. Volume 133, Issue 2.
  • American Academy of Pediatrics. Herpes Simplex. In: eds. Red Book: 2021-2024 Report of the Committee on Infectious Diseases. American Academy of Pediatrics; 2021; 407-417.
  • Pantell, R., et al. Evaluation and Management of Well-Appearing Febrile Infants 8 to 60 Days Old. Pediatrics. August 2021, 148 (2) e2021052228; DOI: https://doi.org/10.1542/peds.2021-052228.
  • Melissa Held, MD, Infectious Diseases and Immunology
  • Grace Hong, APRN, Infectious Diseases and Immunology
  • Anand Sekaran, MD, Pediatric Hospital Medicine

The clinical pathways in the above links have been developed specifically for use at Connecticut Children’s and are made available publicly for informational and/or educational purposes only. The clinical pathways are not intended to be, nor are they, a substitute for individualized professional medical judgment, advice, diagnosis, or treatment. Although Connecticut Children’s makes all efforts to ensure the accuracy of the posted content, Connecticut Children’s makes no warranty of any kind as to the accuracy or completeness of the information or its fitness for use at any particular facility or in any individual case.