The diagnostic challenge of the infant younger than 60 days presenting to medical attention with fever has been the source of numerous publications, clinical scoring systems, and, more importantly, a high level of clinical uncertainty for caregivers evaluating this population.1- 3 The rate of serious bacterial infection is high enough in this age group to warrant evaluation, but it is unclear how much or how little evaluation is warranted.4 Clinical signs and symptoms have been shown to be unreliable at best, and as a result, there is a high level of clinical variability in emergency departments and clinical wards nationwide.5,6 The true impetus behind the evaluation of infants in this age group presenting with fever is the early recognition and diagnosis of invasive bacterial infections (IBI), thereby preventing the potential morbidity and mortality that comes with these infections.
Mischler M, Orzulak FM, Hanks J. White Blood Cell Count in the Evaluation of the Febrile InfantTime to Revisit the Dogma?. JAMA Pediatr. Published online September 11, 2017. doi:10.1001/jamapediatrics.2017.2796