M.D Universidad Peruana Cayetano Heredia Lima, Lima, Peru
Background: Fever in infants ≤60 days remains one of the most frequent and challenging pediatric emergencies. Roughly 8–13 % of febrile infants have a serious bacterial infection (SBI) and 0.5–2 % an invasive bacterial infection (IBI). In 2021 new biomarker-based, age-stratified algorithms were introduced by AAP to minimize unnecessary interventions. In December 2022, we implemented our institutional pathway based on this guidance. Evidence on real-world adherence and impact among 29–60-day-old infants remains limited. Objective: To evaluate changes in diagnostic testing, management, and short-term outcomes among 29–60-day-old febrile infants following implementation of an AAP-adapted pathway at a large tertiary care children’s hospital. Design/Methods: A retrospective cohort study of well-appearing febrile infants 29–60 days old presenting to our emergency department from January 2021 to December 2024. The institutional pathway—implemented December 2022—incorporated AAP biomarker thresholds (procalcitonin > 0.5 ng/mL, CRP > 20 mg/L, ANC > 4,000/mm³), and 24-h follow-up for outpatients. we excluded infants < 37 weeks GA, congenital anomalies, focal infections, or incomplete data. Pre- (January 2021–December 2022) and post-implementation (December 2022–December 2024) groups were compared using Chi square and Fisher’s exact test. Results: Among 1,484 infants aged 29–60 days (752 pre, 732 post), admission rates declined from 53.9 % to 46.1 % (p = 0.15). LP utilization decreased significantly (11.2 % → 5.5 %, p < 0.05). Ordering of inflammatory markers increased (54.9 % → 61.7 %, p < 0.05), as did urinalysis (40.8 % → 52.5 %, p < 0.05). Procalcitonin positivity remained stable (12.5 % vs 12.1 %), and CRP > 20 mg/L (19.5 % vs 17.1 %, p = 0.44). Viral testing expanded (FARVPP 179 → 259 [p < 0.05]), with higher positivity (49.7 % → 66 %). No increase occurred in missed IBIs: bacteremia 17 cases (1.1 %) pre vs 7 (1.0 %) post; one GBS meningitis case post-implementation. Contaminant rates (≈5 %) and 7-day revisit rates (2.4 % vs 2.6 %) were unchanged.
Conclusion(s): Adoption of a new febrile infant pathway based on the 2021 AAP guideline for 29–60-day-old infants showed no increase in IBIs or re-visit rates while decreasing unnecessary LPs. Our pre-implementation admission rate for this age group was already low, but we were able to further decrease it. Our data supports this pathway was safe and effective for this age group.
