Rosh Review My EMCert Monthly Question

A parent presents to the ED with their 6-week-old infant for evaluation of a fever. The infant was born full term and has no other symptoms. Physical exam is normal and vital signs are HR is 150 bpm, SpO2 is 99%, and a rectal T is 101.4°F (38.6°C). Blood cultures are sent and lab results from a CBC, procalcitonin, and urinalysis are as follows:

WBC: 5,300/µL

Hemoglobin: 12.2 g/dL

Platelets: 205,000/µL

Absolute neutrophil count: 2,600/µL

Procalcitonin: 0.14 ng/mL

Urinalysis

WBC: 50–100/hpf

RBC: 0–4/hpf

Nitrite: positive

Leukocyte esterase: positive

Which of the following is the most appropriate care for this patient?

1. Intravenous antibiotics and hospital admission
2. Lumbar puncture and, if results are normal, discharge home with close outpatient follow-up
3. Lumbar puncture, intravenous antibiotics, and hospital admission
4. Oral antibiotics and discharge home with close outpatient follow-up

References

1. Pantell RH, Roberts KB, Adams WG, et al. Evaluation and management of well-appearing febrile infants 8 to 60 days old. Pediatrics. 2021;148(2):e2021052228. https://publications.aap.org/pediatrics/article/148/2/e2021052228/179783/Clinical-Practice-Guideline-Evaluation-and
2. Rodriguez DM, Nesiama JAO, Wang VJ. Fever and serious bacterial illness in infants and children. In: Tintinalli JE, Ma OJ, Yealy DM, et al., eds. Tintinalli’s Emergency Medicine: A Comprehensive Study Guide. 9th ed. McGraw Hill; 2020:(Ch) 119. https://accessemergencymedicine.mhmedical.com/content.aspx?bookid=2353&sectionid=219644573

FOR THE RIGHT ANSWER CLICK ON THE ROSH REVIEW LOGO BELOW

Post Peer Reviewed By: Salim R. Rezaie, MD (Twitter/X: @srrezaie)