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UCSF Northern California Pediatric Hospital Medicine Consortium

 

Table of Contents

• Executive Summary
• Consensus Guidelines
• Frequently Asked Questions (FAQs)
• References
• Appendix 1: Febrile Infants 0-21 Days Pathway
• Appendix 2: Febrile Infants 22-28 Days Pathway
• Appendix 3: Febrile Infants 29-90 Days Pathway 
• Appendix 4: Suggested Implementation Metrics

 

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Executive Summary

Objectives

• To standardize the diagnosis, work-up, and management of community-onset of fever in previously healthy infants < 90 days of age (adjusted for prematurity) readmitted to the hospital setting.
• To reduce unnecessary testing and prolonged hospitalization of patients.

Recommendations

• All well appealing febrile infants under 21 days of age should undergo workup with blood, urine and csf analysis and culture, and be hospitalized for empiric broad spectrum antibiotic coverage for 24-48 hours while awaiting culture results.
• Well appearing infants aged 22-28 days should undergo blood testing (culture, inflammatory markers), urinalysis and, if UA positive, urine culture.
• If there are elevated inflammatory markers (IM’s), infants in this group should undergo CSF analysis and culture, with hospitalization and empiric IV antibiotics while awaiting results. If there are negative IM’s but positive UA, CSF evaluation is strongly encouraged.
• Infants with positive urinalysis, high risk inflammatory markers or CSF suggestive of meningitis should be hospitalized for empiric IV antibiotics. 
• Infants in this group with low-risk inflammatory markers and negative UA may either be observed in the hospital off antibiotics or, following negative CSF evaluation, be observed at home following antibiotic administration if reliable follow-up within 24 hours is available.
• Well appearing febrile infants aged 29-60 days (corrected for prematurity) should undergo urinalysis and, if positive, urine culture.
• Well appearing febrile infants aged 29-60 days (corrected for prematurity) should undergo blood culture and assessment of inflammatory markers (IM’s).
• Infants with low-risk IM’s, negative UA without CSF evaluation may be observed off antibiotics in the hospital or at home if meeting low-risk and discharge criteria.
• Infants with low-risk inflammatory markers and positive urinalysis may be treated at home with oral antibiotics for presumed UTI, without CSF evaluation, if meeting low-risk and discharge criteria.
• Infants with high-risk inflammatory markers may undergo CSF evaluation. Infants with CSF concerning for meningitis should be admitted for broad spectrum IV antibiotics.
• Well appearing infants with high-risk inflammatory markers should receive IV broad spectrum antibiotics and may be admitted, or they may be observed at home if CSF is negative or uninterpretable and they meet all low-risk and discharge criteria.

Methods

This guideline was developed through local consensus based on published evidence and expert opinion as part of the UCSF Northern California Pediatric Hospital Medicine Consortium.

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Introduction 

Criteria for use of guideline:

This guideline is intended for the risk stratification and supporting management decisions when caring for previously healthy, well appearing, febrile infants (documented fever >38.0C, 100.4F) who are aged less than 90 days and presenting from home/clinic without a clear source of fever. This guideline is not intended to guide workup and management of early onset sepsis in the immediate perinatal period prior to hospital discharge.

Exclusion Criteria Includes: 

• Presence of focal bacterial infection (omphalitis, cellulitis, septic arthritis) as this should be managed per standard practices
• Presence of clinical bronchiolitis with or without positive viral testing
• Infants with complicated perinatal course including surgery, infections, maternal chorioamnionitis
• Infants with chronic illness, congenital malformations or known/suspected immunodeficiencies
• Well appearing infants who have received immunizations in the past 24-48 hours

Disclaimer

These clinical practice guidelines are based upon the evidence-based consensus opinions of consortium members affiliated with UCSF Benioff Children's Hospitals. They are intended to guide pediatric/neonatal providers, but do not substitute for individual clinical judgment. Evaluation and treatment of specific patients should be adapted based upon the unique conditions of each patient, family and clinical environment.

Background

Evaluation and management of febrile infants 0-90 days has historically been fraught with controversy and diversity in practice due to differing guidelines and variation in local resources. Efforts to provide evidence-based approaches have been in place since the 1970’s and led to research such as the Boston, Philadelphia, and Rochester studies which aimed to provide criteria for work-up, admission, and treatment based on age of the infant, clinical appearance, lab work-up--including blood, urine, and CSF studies. However, these three major studies had variation among themselves in terms of specific guidance. Additionally, the recommendations did not provide clarity for certain clinical situations, which led to unnecessary testing and subsequent possible harm, as well as increased costs to the healthcare system. Practice variability in light of these uncertainties has shown to be very prevalent.

With advances in diagnostic testing, such as more sensitive and specific inflammatory markers, improvements in pathogen detection, and ongoing research to help further stratify risk with opportunities to improve costs to both patients and the healthcare system, the AAP published a new clinical guideline in August 2021. This publication consists of an evidence-based review by the Agency for Healthcare Research and Quality to use the most currently available research and clinical decision-making tools to develop algorithms for three age groups of febrile infants: 8-21 days, 22-28 days, and 29 to 60 days of age. The guidance specifies specific exclusion criteria and additionally lists 21 key action items based on available evidence; however, the authors do acknowledge and create space for the variation of practice, and the need for this variation based on local resources, specific clinical situations, and shared decision making with families.

This clinical consensus guideline was developed with local expertise and resources in mind to address some of the gray areas and potentially excluded groups from the 2021 AAP publication (such as infants up to 8 days of age who have been out of the hospital and are re-presenting to the ED, infants with medical complexity, etc).

Evaluation

Laboratory Evaluation: 

The advent of improved clinical biomarkers and aggregated data has significantly improved the sensitivity of laboratory evaluation in identifying infants at high risk for invasive bacterial infection (IBI), particularly when 2 or more inflammatory markers (IM’s) are used in conjunction. Staged evaluation may be tailored based on age and initial results to minimize invasive testing. IM’s that indicate an elevated risk of invasive bacterial infection include:

1. Absolute Neutrophil Count (ANC) >4000
1. WBC alone is a very poor marker (AUC <0.5)
2. ANC cutoff of 10k lacks sensitivity
2. CRP: >20 mg/L (2.0 mg/dL)
3. Procalcitonin: >0.5 ng/mL. 
1. Most accurate single marker
4. Temperature >38.5C
1. While not an inflammatory marker, each 1 degree celcius increase above 38.5° C is associated  w/ OR 1.8x increase in risk of IBI

**HSV Testing: Consider testing and empirically treating for HSV if risk factors exist including:

• CSF pleocytosis
• Transaminitis, leukopenia or thrombocytopenia
• Seizures, altered mental status or focal neurologic change
• Vesicles or clustered lesions suspicious for HSV
• Hypothermia
• Maternal history of vesicles or fever within 48 hours of delivery

Imaging

• Consider CXR in infants who have severe unexplained respiratory distress. No utility for CXR in infants that do not have any pulmonary signs. Furthermore, viral etiology is most likely when lower respiratory tract infection is diagnosed.
• Non-urgent renal US is indicated if UTI is diagnosed. VCUG may be indicated to evaluate for vesicoureteral reflux in neonates with abnormal renal US, non-E. coli pathogens or recurrent UTI (consider urology referral). No need to get VCUG for first-time febrile UTI, unless indicated by abnormal US or resistance to treatment.
• Neuroimaging may be warranted if a patient is presenting with neurologic symptoms, but it is outside the scope of this guideline to recommend type or timing of imaging in these situations.

Management

Indications for admission and treatment  

• Admit these groups:
• Ill-appearing infants (+/- ICU)
• Patients below 60 days who are not at low risk for serious bacterial infection as per PECARN rule (low risk if UA negative AND ANC<4,000 AND procalcitonin <0.5)
• ALL 0-21 day-old febrile infants while awaiting culture results (regardless of whether or not they are being treated with antibiotics)
• Consider admission for these groups:
• Some 22-28 day-old febrile infants if inflammatory markers, urine and CSF are not all obtained and normal (exception: patients with enterovirus positive CSF may be discharged home)
• Any 29-60 day-old febrile infants whose inflammatory markers are abnormal and they do not meet criteria for clinical bronchiolitis or other identified infectious source 
• Febrile infants of any age when any of these criteria are not fulfilled (as discussed and agreed by clinician and parents): reliable means of communication and transportation, parents willing to observe and communicate changes in condition, agreement to the infant being reevaluated in 24 hours
• Consider discharge from the ED for these groups:
• Not younger 22 days and well-appearing
• Infants 22-28 days after administering broad-spectrum antibiotics AND if urine, CSF, and inflammatory markers are obtained and normal AND child is well appearing, AND follow-up/transportation/communication criteria as above
• Infants 29-60 days with normal urine and inflammatory markers AND follow-up/transportation/communication criteria as above

Medications

 

* See UCSF IDMP resource https://idmp.ucsf.edu/content/fever-without-source-young-infant

** This recommendation is for infants with suspected meningitis based on specific clinical signs (e.g. seizure, neurologic changes) or symptoms, or CSF pleocytosis.

See UCSF IDMP resource https://idmp.ucsf.edu/content/meningitis-0

*** If meeting criteria for oral treatment of UTI as outlined in UCSF IDMP resource https://idmp.ucsf.edu/content/urinary-tract-infections-community-onset, 

**** Acyclovir should be initiated if HSV risk factors exist (see laboratory section on HSV)

+ See safety criteria for Ceftriaxone administration in neonates: https://idmp.ucsf.edu/content/safety-criteria-ceftriaxone-administration-neonates

 

For more information and specific dosing of antimicrobial agents, alternative therapies, and rationale, please visit the UCSF Infectious Diseases Management Program (IDMP) websites for empiric therapy for

Fever without a Source in Young Infants

https://idmp.ucsf.edu/content/fever-without-source-young-infant

and

Meningitis:

https://idmp.ucsf.edu/content/meningitis-0

 

Discharge Criteria:

• Can discontinue antibiotics if all of the following criteria are met:
• all bacterial cultures show no growth at 24-36 hours
• clinically improved
• no fevers
• no other treatable infection found
• Can discharge:
• when able to discontinue antibiotics as above, or tolerating oral antibiotics if bacterial source of infection diagnosed
• no other reason to keep in hospital
• follow up provider visit scheduled prior to discharge
• recommended follow up within 48hrs of discharge
• After discharge ensure cultures are followed until final result (typically 5 days)

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FAQ’s

**Disclaimer: The answers here are based on a combination of expert consensus of our consortium group and any available evidence. Many of these recommendations don’t have readily available evidence or data to support clear clinical guidelines, but it is our hope to provide some guidance for in-the-moment decision making, which can be difficult in these situations.

1)   Does it matter how and where a temperature was measured?

A temperature >38.0 measured by axillary or rectal thermometer at home or by a provider should be considered a true fever and age-appropriate workup should be completed, as axillary measurements average 0.25° C lower than rectal measurements (gold standard). Temperature 38.0-38.3° C measured by temporal scan, or reported tactile fever should be confirmed upon arrival to the emergency department with rectal temperature, as temporal artery measurements average 0.3° C higher than rectal measurements (Syrkin-Nikolau et al). If confirmatory temperature is normal, and the infant is well appearing, the provider may use clinical discretion and shared decision making with the family regarding age-appropriate laboratory workup and observation (especially for infants greater than or equal to 29 days of life). If the family brought the thermometer they used at home, you may be able to compare accuracy in the ED.

2)   How does viral testing affect outcome and management?

Viral testing advances have led to increased ability to rapidly screen for common viral pathogens, however the degree to which viral-positivity impacts risk of IBI varies by age and virus type, and there is insufficient data to create formal blanket recommendations. It can be said with confidence that if multiplex viral testing is performed and negative there is an increased relative risk of bacterial infection, with RR ranging from 2-5 depending on age and type of IBI.

 For infants < 29 days, rate of IBI in virus-positive infants has been shown to range from 3%-13%, lower than the rate of viral-negative patients but variable in terms of significance and by virus. For older infants > 29 days of age, virus positivity has demonstrated significant reductions in risk of IBI for all virus types relative to virus-negative infants (Blaschke et al). Non-rhinovirus pathogens are associated with lower risk of all types of bacterial infection relative to rhinovirus positive infections, and rhinovirus positivity (most common) does not lower risk of UTI. Viral positivity may inform shared-decision making for tiered testing in older infants, however the benefits must be weighed against the significant cost of multiplex viral testing. Consider rapid RSV/Flu testing (seasonally) as an economic alternative (and when it will change management). Remember, bronchiolitis remains a clinical diagnosis (not requiring viral testing) in all age groups and is an exclusion criteria from the 2021 AAP Febrile Infant recommendations.

2b) What about SARS-CoV-2 testing?

An infant may be tested for SARS-CoV-2, but a positive test result does not necessarily exclude the patient from the appropriate work-up based on their age group. Treat COVID-19 infection the same as any other viral infection in an infant with fever (see above).

3)   What is the appropriate workup and management of infants in the case of an identified infectious source? 

If an infant (< 28 days of age) has fever and other signs of infection, this would warrant a full workup as this age group has a high overall risk of IBI. If no fever is present, and there are clear signs of an isolated infection, it is reasonable to treat per the guidelines for that particular infection and then use combined decision making with family to determine further workup and need for hospital admission. Consider a full workup in all infants in this age group regardless of presence of fever. For example, there are certain infections, such as omphalitis, that are a medical and surgical emergency in this age group and would require admission regardless of presence of fever/systemic symptoms. If unsure, consult pediatric infectious disease (ID).

For infants >28 days of age, regardless of fever, if otherwise clinically stable, one may treat the isolated infection (i.e. cellulitis) and discharge with appropriate follow up–again taking into account the resources and availability of close follow up for that patient.

4)   How do we stratify HSV risk?

It is important to have a high index of suspicion with HSV infection in neonates, as despite advances in testing and treatment, the morbidity and mortality rates continue to be high. If left untreated, mortality rates are as high as 75% in this age group and neonatal HSV affects about 1500-2000 neonates in the US each year. (Akthar et al)

The following signs/symptoms should alert the clinician to a possible risk of HSV infection, and warrant testing and treatment with IV Acyclovir WHILE awaiting results:

• CSF pleocytosis without bacterial profile
• Transaminitis, leukopenia or thrombocytopenia
• Seizures, altered mental status or focal neurologic change
• Vesicles or clustered lesions suspicious for HSV
• Hypothermia
• Maternal history of vesicles or fever within 48 hours of delivery

Note that infants in the 2nd week of life (7-14 days old) are at highest risk for HSV infection with an otherwise well-appearing exam. Lack of maternal history of HSV does not necessarily preclude HSV infection, and in fact, could present a higher risk of primary perinatal infection. It is reasonable to obtain a CMP in an otherwise well-appearing infant < 28 days to evaluate for elevated transaminases–although normal AST and ALT do not rule out HSV.

5)   What if procalcitonin is not available?

For infants 22-28 days of age, treat as you would infants in the < 21 day age group. Per the AAP guidelines, it is also reasonable to use a combination of CRP, ANC, and temperature thresholds in lieu of procalcitonin. For older age groups, use CRP and ANC as the inflammatory markers to influence decision making in the pathway.

6)   Should we correct for gestational age in premature infants to determine which pathway they fall under?

For otherwise healthy late preterm infants, one approach is to use their chronological age to place them on the pathway. For infants born < 34 weeks of age, it is reasonable to use adjusted GA until 90 days of age to place them on the pathway to determine risk.

This is a gray area where not a lot of evidence exists, but these are approaches that can be used to simplify workflow in an otherwise well-appearing infant.

7)   Should we do additional testing for 0-8 day olds?

Infants 0-8 days of age should be placed on the < 21 day of age pathway. No additional testing needed, unless there are additional clinical signs/symptoms that warrant additional testing (i.e. CNS imaging, etc). Consult neonatology if unsure.

8)   What about hypothermia?

Normal rectal temperature in neonates is 36.5 to 37.5° C, with hypothermia being defined by the WHO as a core temperature <36.5° C.

Hypothermia in infants can be the result of a variety of factors, in addition to sepsis, such as: environmental causes (i.e. inadequate dress for the ambient temperature), metabolic conditions, prematurity, hypoglycemia, intracranial hemorrhage, or neonatal abstinence syndrome.

For an infant that presents with hypothermia, who is otherwise well-appearing and clinically stable, it is reasonable to first try to warm the baby either by bundling/dressing or placing under a warmer. If hypothermia is persistent over 2 hours with q30 minute rectal temperature checks, despite appropriate bundling, it is reasonable to proceed down the appropriate work-up algorithm for age. Keep in mind that severe life-threatening infections, including HSV infection, can sometimes present with low temperatures/hypothermia however the available evidence suggests that these patients also typically have other accompanying symptoms and are not “clinically well”.

9)   What is the normal WBC in CSF by age in newborns?

The following ranges by age should be used to determine CSF pleocytosis:

Infants < 28 days: CSF WBC >15 cells/mm3

Infants 29-60 days: CSF WBC> 9 cells/mm3

Additional reference:

 

10)   How should we treat missing data such as an unsuccessful LP or bladder catheterization?

Depending on the patient’s age range, it is appropriate to utilize shared decision making with parents/family. For infants < 21 days of age, they will likely be admitted regardless. For infants greater than or equal to 29 days of life, a reasonable approach, if otherwise well-appearing, is to admit without starting antibiotics for observation and resolution of fever.

For infants 22-28 days of age, if inflammatory markers are obtained and normal, and LP is done but uninterpretable, one may either chose to admit and observe closely off antibiotics until cultures come back OR discharge home after a dose of parenteral antibiotics with close follow up and call back with culture results in 24hrs.

If the patient clinically worsens during the observation period, a repeat workup (including previously unsuccessful procedures), starting antibiotics, and/or transfer to a tertiary center would be appropriate.

 

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References

Published Children’s Hospital Guidelines / Pathways

Akhtar L, Kimberlin D, The Changing Landscape of Neonatal Herpes Simplex Virus Disease, Journal of the Pediatric Infectious Diseases Society, 2021;, piab118, https://doi.org/10.1093/jpids/piab118

Blaschke AJ, Korgenski EK, Wilkes J, Presson AP, Thorell EA, Pavia AT, Knackstedt ED, Reynolds C, Schunk JE, Daly JA, Byington CL. Rhinovirus in Febrile Infants and Risk of Bacterial Infection. Pediatrics. 2018 Feb;141(2):e20172384. doi: 10.1542/peds.2017-2384. Epub 2018 Jan 17. PMID: 29343585; PMCID: PMC5810600.

Bonadio W, Maida G. Urinary tract infection in outpatient febrile infants younger than 30 days of age: a 10-year evaluation. Pediatr Infect Dis J. 2014;33(4):342-344. doi:10.1097/INF.0000000000000110

Bramson RT, Meyer TL, Silbiger ML, Blickman JG, Halpern E. The futility of the chest radiograph in the febrile infant without respiratory symptoms. Pediatrics. 1993;92(4):524-526.

Edwards M, Clinical features, evaluation, and diagnosis of sepsis in term and late preterm infants. In: UpToDate, Armsby C (Ed), UpToDate, (Accessed August 9th, 2022)

Kasmire, Kathryn E. MD, MS; Vega, Carolina MD*; Bennett, Nicholas J. MA (Cantab), MBBChir, PhD; Laurich, V. Matt MD; Hypothermia, Pediatric Emergency Care: March 2021 - Volume 37 - Issue 3 - p e124-e128 doi: 10.1097/PEC.0000000000001539

Kuppermann N, Dayan PS, Levine DA, et al. A Clinical Prediction Rule to Identify Febrile Infants 60 Days and Younger at Low Risk for Serious Bacterial Infections. JAMA Pediatr. 2019;173(4):342-351. doi:10.1001/jamapediatrics.2018.5501 

Mahajan P, Browne LR, Levine DA, Cohen DM, Gattu R, Linakis JG, Anders J, Borgialli D, Vitale M, Dayan PS, Casper TC, Ramilo O, Kuppermann N; Febrile Infant Working Group of the Pediatric Emergency Care Applied Research Network (PECARN). Risk of Bacterial Coinfections in Febrile Infants 60 Days Old and Younger with Documented Viral Infections. J Pediatr. 2018 Dec;203:86-91.e2. doi: 10.1016/j.jpeds.2018.07.073. Epub 2018 Sep 6. PMID: 30195552; PMCID: PMC7094460.

Melvin A,  Mohan K, Neonatal Herpes Simplex Virus Infection: Epidemiology and Outcomes in the Modern Era, Journal of the Pediatric Infectious Diseases Society, 2021;, piab105, https://doi.org/10.1093/jpids/piab105

Pammi M. Clinical features and diagnosis of bacterial sepsis in preterm infants < 34 weeks gestation. In: UpToDate, Wilkie L (Ed), UpToDate, (Accessed August 9th, 2022)

Pantell RH, Roberts KB, Adams WG, et al. Evaluation and Management of Well-Appearing Febrile Infants 8 to 60 Days Old [published correction appears in Pediatrics. 2021 Nov;148(5):]. Pediatrics. 2021;148(2):e2021052228. doi:10.1542/peds.2021-052228

Syrkin-Nikolau ME, Johnson KJ, Colaizy TT, Schrock R, Bell EF. Temporal Artery Temperature Measurement in the Neonate. Am J Perinatol. 2017 Aug;34(10):1026-1031. doi: 10.1055/s-0037-1601440. Epub 2017 Apr 10. PMID: 28395367; PMCID: PMC5532079.

 

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Appendix 1: Febrile Infants 0-21 Days Pathway

 

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Appendix 2: Febrile Infants 22-28 Days Pathway

 

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Appendix 3: Febrile Infants 29-90 Days Pathway

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Appendix 4: Suggested Implementation Metrics

Primary Measures

• Appropriate CSF 
• Definition
• 90% of infants 29-90 days with normal inflammatory markers (and either a negative UA OR a positive UA) DO NOT have CSF obtained
• Numerator
• Infants 29-90 days with normal inflammatory markers (and either a negative OR a positive UA) who DO NOT have CSF obtained 
• Denominator
• All infants 29-90 days with normal inflammatory markers (and either a negative UA OR a positive UA) 
• Appropriate disposition from the emergency department 
• Definition
• 90% of infants 29-90 days with normal inflammatory markers and negative UA discharged from the ED 
• Numerator
• Infants 29-90 days with normal inflammatory markers and a negative UA who are discharged from the ED 
• Denominator
• All infants 29-90 days with normal inflammatory markers and a negative UA 
• Appropriate receipt of antibiotics 
• Definition
• 90% of infants 29-90 days with normal inflammatory markers and negative UA DO NOT receive antibiotics 
• Numerator
• Infants 29-90 days with normal inflammatory markers and negative UA who DO NOT receive antibiotics 
• Denominator
• All infants 29-90 days with normal inflammatory markers and negative UA 
• Appropriate discontinuation of antibiotics 
• Definition
• 90% of infants 0-90 days with negative cultures have appropriate discontinuation of antibiotics within 36 hours from the time blood cultures were received by the laboratory 
• Numerator
• Hospitalized infants 0-90 days with negative cultures who had antibiotics discontinued within 36 hours 
• Denominator
• All hospitalized infants 0-90 days (important to exclude newborns who have not yet been discharged from the hospital after birth) with negative cultures 

Process Measures

• Appropriate evaluation (0 – 21 days)
• Definition
• % of infants 0-21 days who have a urinalysis and/or urine culture, blood culture, and CSF culture obtained, and who are hospitalized on parenteral antibiotic therapy 
• Numerator
• Infants 0-21 days who have a urinalysis and/or urine culture, blood culture, and CSF testing including culture obtained, and who are hospitalized on parenteral antibiotic therapy  
• Denominator
• Infants 0-21 days who present to the emergency department or hospital with fever (important to exclude newborns who have not yet been discharged from the hospital after birth) 
• Appropriate evaluation (22 – 90 days)
• Definition
• % of infants 22-90 days who have a urinalysis and/or urine culture, blood culture, and inflammatory markers obtained 
• Numerator
• Infants 22-90 days who have a urinalysis and/or urine culture, blood culture, and inflammatory markers obtained 
• Denominator
• Infants 22-90 days who present to the emergency department or hospital with fever 

Balancing Measures

• Emergency department revisit 
• Definition
• % of infants 22-90 days who did not have CSF obtained or did not receive antibiotic therapy who return to the emergency department within 7 days of discharge 
• Numerator
• Infants 22-90 days who did not have CSF obtained or did not receive antibiotic therapy who return to the emergency department within 7 days of discharge 
• Denominator
• All infants 22-90 days who are evaluated for a fever and who did not have CSF obtained or receive antibiotic therapy 

• Readmission
• Definition
• % of infants 22-90 days who did not have CSF obtained or receive antibiotic therapy who are readmitted to the hospital within 7 days of discharge 
• Numerator
• Infants 22-90 days who did not have CSF obtained or receive antibiotic therapy who are readmitted to the hospital within 7 days of discharge 
• Denominator
• All infants 22-90 days who are evaluated for a fever and who did not have CSF obtained or receive antibiotic therapy 

Equitable Care

• Definition
• Across all outcome and process measures for infants 0-90 days, there will be equitable distribution across race and ethnicity 
• Numerator
• Infants 0-90 days who are Non-Hispanic Black, Non-Hispanic White, and Hispanic in the numerators above  
• Denominator
• Infants 0-90 days in the denominators above

 

UCSF Northern California Pediatric Hospital Medicine Consortium. Originated 08/2022

Approved by UCSF Pharmacy and Therapeutics Committee: 04/2023

This work is licensed under a Creative Commons Attribution-Non-Commercial 4.0 International License https://creativecommons.org/licenses/by-nc/4.0/