Hi, everyone, and welcome back to another episode of E.M. Basic. We've got here today with us,

Zach Hodges, as well as Dr. Catherine McLeod, a pediatric hospitalist.

Hi, everyone. My name is Zach Hodges. I'm a pediatric resident at the Medical College of Georgia

at Augusta University, and I will be your host. Today we'll be discussing the management

of the well-appearing febrile infant less than 60 days old.

I want to emphasize well-appearing.

We'll save the discussion of the critically ill neonate for another time.

Dr. McLeod, will you get it started by giving us some background information and tell us why this topic is so important?

Yes, well, obviously, fever and young infants is common and seen daily in most pediatric emergency departments.

In these young infants, fever often is the only sign of infection. Even febri infants can be

well appearing, but remain at high risk of bacterial infections. Unfortunately, since most of these

infants will have a normal physical exam, the exam is often unhelpful to

differentiate infants with a self-limited viral illness from those who are presenting with early

signs of potentially significant bacterial infection. Currently, there are no consensus guidelines

regarding the optimal management of these patients, but there are some new tools

like the step-by-step approach and the P-Carn rule for febrile infants that we will discuss later

that can help distinguish which well-appearing infants may be at lower risk for bacterial infection.

Hopefully, by the end of this discussion, we will all know more about which infants require

a full evaluation and paracantibiotics and emission versus those that may be safe for limited

evaluation and outpatient management. Let's work through a clinical case to get us started.

Our patient is a six-week-old female infant brought to the emergency department with a history of fever at home.

Her mother reports no other symptoms, including rhinorrhea, cough, vomiting, diarrhea, or rash.

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