AAP issues guidance on evaluating and managing fever in infants

The AAP issued guidance on evaluating and managing fevers in infants aged 8 to 60 days who have a temperature at or above 100.4°F but appear otherwise healthy.

According to the AAP, most fevers in infants do not lead to severe illness, but it can be challenging to identify the cause while avoiding unnecessary testing or hospitalization.

“Babies at this age are too young to describe how they feel, and so a fever is an important signal that something is wrong,” Benard P. Dreyer, MD, FAAP, co-author of the guidance, said in a news release.

According to the guidance, which was written by the AAP Council on Quality Improvement and Patient Safety’s Subcommittee on Febrile Infants, approximately 14 out of every 1,000 healthy infants born full term develop a fever between the ages of 8 and 60 days, and more than 10% of febrile infants are diagnosed with a UTI.

Each guideline is ranked according to the quality of available evidence to back it. The authors detail the risks and benefits of the guidelines, including recommendations concerning invasive procedures, such as lumbar puncture or bladder catheterization.

Among the recommendations, the committee said it supports not performing a lumbar puncture in febrile infants if they are otherwise healthy and all inflammatory markers are normal. However, it also notes that parents and physicians may have “differences in risk tolerance” when it comes to the procedure.

“A clinician may estimate that an infant’s risk of meningitis is 1% and [a lumbar puncture] is indicated, whereas a parent may have a higher threshold for consenting to the procedure,” Dreyer and colleagues wrote.

Such differences “provide further challenges in an effort to share decision-making in an acute setting,” they wrote.

“As we learn more about the risks and benefits of treating infants, we offer evidence-based recommendations for physicians to consider,” Dreyer said. “We also acknowledge the significant role that parents play in the decision-making process as informed participants in the process.”

The guidance includes recommendations for three age groups — 8 to 21 days, 22 to 28 days and 29 to 60 days. Infants in their first week of life have different needs and are not included in the report, the AAP noted.

“Whenever a baby this young develops a fever, parents should call their pediatrician to have their baby evaluated,” Sean O’Leary, MD, MPH, FAAP, co-author of the guidance, said in the news release. “Most children do well, but some have serious infections, and at such a young age, it’s next to impossible for a parent to distinguish who has a serious infection and who doesn’t.”

The guidelines were published in Pediatrics.

References:

Pantell RH, et al. Pediatrics. 2021;doi:10.1542/peds.2021-052228.