Febrile Infant Clinical Pathway – Emergency Department and Inpatient – History and Physical

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 hrs
  • Presence of vomiting/diarrhea, weight loss in past 24 hrs
  • 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