The Febrile Infant: Where Art Meets Science to Prevent Harm

Abstract

1. Mobeen H. Rathore, MD, CPE*\n\n\n \n\n1. *Editorial Board Member, Pediatrics in Review\n\n> With a nod (tongue in cheek) to the author’s previously published title (1) \n\n> One consistent thought continues to hold true when it comes to assessing the febrile infant. Be suspicious.\n> \n> —JZ, HDA\n\nPerhaps Dr Arnold Smith put it most eloquently: “Sorting out the child at risk, from those with illness that is not a threat to their health, is a fundamental goal of pediatrics” (Fig 1). (2) What Dr Smith wrote 40 years ago is true even today. Fever continues to be one of the most common ailments in children. Although fever is a friend of the patient, infection is a foe. Identifying the foe is a complicated task for the evaluating physician. This is even more challenging in infants and especially neonates because of less-than-optimal history, mostly unreliable examination, and more specific signs of infection in the neonates often appearing later in the disease course. Even a thorough laboratory evaluation is not always helpful. Ultimately it is the selection of optimum broad spectrum empirical antibiotic drug therapy that is really the most important decision to protect neonates from the serious morbidity and mortality of neonatal sepsis. Fortunately, most infections in children, including in neonates, are viral and self-limited, causing no serious morbidity. Unfortunately, rarely, bacterial infections can be serious and sometimes life-threatening. Herein lies the challenge even for the most experienced and knowledgeable …