Febrile Infant Clinical Pathway — Emergency Department and Inpatient

History

HPI	Fever maximum, method obtained, duration Use of acetaminophen Oral intake/urine output in past 24 hours Presence of vomiting/diarrhea, loss in past 24 hours Change in behavior URI symptoms Rash Ill contacts, recent immunizations or antibiotics
PMH	Birth history Pregnancy, delivery, prematurity, birth weight N/IICU, newborn nursery course Infectious risk factors Mother known to have primary HSV infection at delivery Maternal fever or history of infection: Group B strep, maternal treatment Gonorrhea, chlamydia, or syphilis HSV, lesions during perinatal period IV
Newborn Screen	Normal or abnormal

Physical

Physical Exam	Vital signs, weight General appearance Signs of infection, cardiac or metabolic disease Neurologic status: Tone Responsiveness Seizure-like activity Skin: Jaundice Rashes Mottling Perfusion Cellulitis/abscess

Ill-appearing Infant

Signs of an ill-appearing infant can include but are not limited to:

Tachypnea, apnea, grunting
Poor color (pale, gray, cyanotic), mottled appearance, poor perfusion
Poor tone, limp, weak cry
Bulging fontanelle
Irritability, inconsolability, decreased alertness and reactivity, listlessness, lethargy

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The clinical pathways are based upon publicly available medical evidence and/or a consensus of medical practitioners at The Children’s Hospital of Philadelphia (“CHOP”) and are current at the time of publication. These clinical pathways are intended to be a guide for practitioners and may need to be adapted for each specific patient based on the practitioner’s professional judgment, consideration of any unique circumstances, the needs of each patient and their family, and/or the availability of various resources at the health care institution where the patient is located.

Accordingly, these clinical pathways are not intended to constitute medical advice or treatment, or to create a doctor-patient relationship between/among The Children’s Hospital of Philadelphia (“CHOP”), its physicians and the individual patients in question. CHOP does not represent or warrant that the clinical pathways are in every respect accurate or complete, or that one or more of them apply to a particular patient or medical condition. CHOP is not responsible for any errors or omissions in the clinical pathways, or for any outcomes a patient might experience where a clinician consulted one or more such pathways in connection with providing care for that patient.