Objective: To assess the common practices for evaluation and treatment of fever in infants aged ≤60 days in a nationwide survey.
Patients and Methods: Questionnaires were administrated to pediatric infectious diseases (PID) specialist or heads of pediatric departments in all 25 hospitals which have a pediatric department in Israel.
Results: Of the 25 centers surveyed (100% response rate), only 36% had written protocols concerning the approach to young febrile infants. The existence of a written protocol was significantly associated with the level of medical center (tertiary vs. primary and secondary, p=0.041) and with the number of local PID specialists (p=0.034). All centers use the Rochester criteria or its modification. In 13 (52%) hospitals, a normal white blood cell count was defined as 5000-15000 cells/ml, 20 (80%) centers use C-reactive protein, and none used procalcitonin routinely. Hospitalization was mandatory in most centers (96%) for all febrile neonates aged 28 days or less. However, low risk febrile infants aged 29-60 days were hospitalized in most (68.4%) of the primary and secondary hospitals in Israel compared with 33.3% tertiary centers. A combination antibiotic regimen of ampicillin and gentamicin was the routine empiric antibiotic treatment for febrile infant in 92% of centers.
Conclusion: There are significant differences among medical centers in the evaluation of febrile infants aged ≤60 days, depending on hospital level and presence of local PID specialist. These differences reflect the lack of and highlight the need for national or international guidelines for the evaluation of fever in this age group.
