Fever in infants less than two months of age: Spectrum of disease and predictors of outcome

Carol D. Berkowitz*, Naomi Uchiyama, Susan B. Tully, Richard D. Marble, Mary Spencer, Martin T. Stein, Donald P. Orr

*Corresponding author for this work

Research output: Contribution to journalArticlepeer-review

19 Scopus citations


Four hundred thirty-four febrile infants two months of age or younger were evaluated in the emergency departments of five major teaching hospitals over a one-year period. A culture-proven bacterial infection was present in 3.5% of the infants; bacteremia was detected in 3.3%. Bacterial meningitis was present in 2.4%, and aseptic meningitis was noted in 13.4%. Twenty-one percent had clinically apparent serious disease including pneumonia, otitis media, and gastroenteritis with dehydration. Six variables (age <1 month, lethargy, no contact with an ill individual, breast-feeding, total polymorphonuclear > 10,000/mm3 and band count > 500/ mm3) were correlated with bacterial infection by stepwise discriminant analysis. However, these findings were neither sensitive nor specific enough to be clinically useful. Management varied, and 62% of the infants were hospitalized. Fifty-four percent, some of whom were managed as outpatients, received antibiotics. Febrile infants two months of age or younger require a comprehensive emergency department assessment, including appropriate laboratory studies (CBC, differential, urinalysis and culture, lumbar puncture, and blood culture), since 3.5% have bacterial infection that may be life-threatening. Hospitalization is warranted if the infant appears ill, laboratory studies indicate serious infection, or follow-up care is uncertain.

Original languageEnglish (US)
Pages (from-to)128-135
Number of pages8
JournalPediatric emergency care
Issue number3
StatePublished - Sep 1985

ASJC Scopus subject areas

  • Pediatrics, Perinatology, and Child Health
  • Emergency Medicine


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