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March 10, 2004

Young, Febrile InfantsA 30-Year Odyssey Ends Where It Started

Author Affiliations

Author Affiliation: Moses Cone Health System, Greensboro, NC.

JAMA. 2004;291(10):1261-1262. doi:10.1001/jama.291.10.1261

Thirty years ago, senior pediatric residents assigned to the emergency department (ED) at Johns Hopkins Children's Center identified management of febrile infants younger than 2 months as one of the clinical problems they found most vexing. The residents believed that their clinical judgment was demeaned by the prevailing notion that all young, febrile infants need a complete evaluation for invasive bacterial disease, regardless of clinical appearance. They knew that pediatricians in practice caring for febrile infants performed fewer tests and hospitalized less.1 This dissonance between the rules in academic medical centers and the behavior in office practices prompted a study to demonstrate whether the residents could, in fact, identify which febrile infants had invasive bacterial disease, requiring hospitalization and intravenous antibiotic treatment, and which did not.2 Of the 61 infants enrolled during the 8 months of the study, one 17-day-old infant considered to be well appearing by the residents had group B streptococcal bacteremia. The study reinforced the notion that clinical judgment (at least of senior residents) could not reliably identify all infants with invasive bacterial disease.

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