Ep 212 PECARN Febrile Young Infant Prediction Tool: When To Safely Forgo LP and Empiric Antibiotics

Emergency Medicine Cases

Dr. Anton Helman

Education, Health & Fitness, Courses, Medicine, Science

4.7 • 602 Ratings

🗓️ 27 January 2026

⏱️ 48 minutes

🔗️ Recording | iTunes | RSS

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Summary

If you’ve been practicing EM for more than a decade, your approach to the febrile young infant has (appropriately) evolved. For years, the default was LP + empiric antibiotics + admission for almost everyone. That approach prevented missing meningitis, but at the cost of a lot of harm: invasive testing, unnecessary antibiotics, and hospitalization-related complications. The modern approach is a paradigm shift toward risk stratification, biomarkers, and shared decision-making, while still respecting one immutable truth: Missing neonatal bacterial meningitis can be catastrophic. This episode revisits the framework from a prior EM Cases episode and updates it with a landmark study that directly informs how far we can safely go—especially in the 0–28 day group, with the father of multiple well-known PECARN rules Dr. Nathan Kuppermann and lead author Dr. Brett Burstein...

Transcript

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0:00.0	Welcome to the Emergency Medicine Cases Podcast. I'm your host, Dr. Anton Hellman, bringing you the brightest minds in emergency medicine from around the world. EMCases is brought to you by Shremi, the Schwartz-Riesman Emergency Medicine Institute. That's a non-profit organization dedicated to improving EM care through high-quality research and education. The opinions expressed on this podcast are intended for information and education purposes only and should not be used to diagnose treat or prevent any medical condition, nor should they be used as a substitute for medical advice from qualified practicing physicians.
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1:31.7	If you've been practicing emergency medicine for more than a decade, your approach to the
1:36.7	febrile infant has almost certainly evolved and appropriately so.
1:41.9	Historically, most febrile young infants underwent routine lumbar puncture,
1:46.8	empiric antibiotics, and admission, regardless of your initial bedside assessment. That approach
1:53.2	undoubtedly prevented missed cases of meningitis, but it also exposed large numbers of infants
1:59.8	to invasive LPs, unnecessary antibiotics, and
2:03.6	hospitalization-related harm. Now, over the past decade, we've moved toward a risk stratification,
2:11.3	biomarkers, and shared decision-making strategy while still respecting how catastrophic
2:17.3	missed neonatal meningitis can be.
	...

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