Patient: febrile infant under 3 months of age
Selection criteria:
(1) step-by-step approach of Mintegi et al indicates that the infant is low risk for a serious bacterial infection
(2) there are no indications to perform a lumbar puncture
Indications to perform a lumbar puncture - one or more of the following:
(1) not well-appearing
(2) clinical findings consistent with meningitis
(3) age < 21 days old
(4) absolute neutrophil count > 10,000 per µL
(5) serum CRP > 20 mg/L
(6) serum procalcitonin >= 0.5 ng/mL
These indications are all included in the step-by-step approach to indicate high risk.
Protocol:
(1) observe the infant in the observation unit of the ED for < 24 hours
(2) if the infant is table then discharge without antibiotics if close follow-up feasible
The vast majority of these infants did not develop a serious bacterial infection.
