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Neonatal Fever In The Term Infant: Evaluation And Management Strategies

Abstract
The presence of fever in the neonatal period demands urgent evaluation from healthcare providers since signs and symptoms of a serious bacterial infection in this age group can be nonspecific. Current practice guidelines recommend that febrile neonates should be presumed to have a serious bacterial infection and undergo a sepsis evaluation and hospitalization until the results of diagnostic testing are known. However, less than 50% of outpatient practitioners in a recent study followed these recommendations without apparent adverse outcomes even though the rate of serious bacterial infections in the neonatal period is higher than febrile infants 1-3 months of age. In this article we examine various clinical scenarios that healthcare providers confront when caring for febrile neonates, including whether febrile neonates with respiratory syncytial virus are at increased risk for developing a serious bacterial infection and whether diagnostic testing and empiric antiviral therapy for herpes simplex virus should be part of the standard evaluation of febrile neonates. Although the discovery of inflammatory mediators that are elevated during the early stages of infection has the potential to improve diagnostic capabilities in this age group, there is enough evidence to support international guidelines recommending hospitalization and sepsis evaluations in febrile neonates.
KEY WORDS: neonate, fever, sepsis, guidelines, infection

Introduction
Fever (temperature ≥ 38.0° C) in the neonatal period (≤ 30 days) can be an important underlying cause of severe infection because of the immaturity of the neonatal immune system. In fact, the annual incidence of severe sepsis in United States in children ≤ 19 years of age is highest in neonates (3.60 per 1,000 population) with over a 10% case fatality rate leading to an estimated 1361 deaths per year [1] compared to 1.6 million deaths annually in developing countries [2]. Infections during the neonatal period can...