Neonatal Fever (0 - 29 days)



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Neonatal Fever (0 - 29 days)

Ceftriaxone and bilirubin

  • Ceftriaxone may interfere with bilirubin excretion and should be avoided in neonates < 30 days or at high risk of hyperbilirubinemia

If LP attempted and unsuccessful

  • Send any CSF obtained for Cx
  • Admit
  • Start empiric antibiotics

Gastroenteritis PCR, Stool

Replace Ampicillin with Vancomycin

Vancomycin injection

Respiratory Symptoms

  • Respiratory rate >50
  • Rales
  • Rhonchi
  • Retractions
  • Wheezing
  • Coryza
  • Grunting
  • Stridor
  • Nasal flaring
  • Cough

Acetaminophen suspension

Contraindications to acetaminophen

  • Allergy or hypersensitivity
  • Hepatic impairment
  • Severe hypovolemia
  • PKU or other liver disease
  • Chronic malnutrition

CSF WBC >20/mm3?

X-ray Chest, 1 view
Respiratory Viral Panel, Nasopharyngeal
Admit to ICU

Diarrhea?

Abscess, umbilical or other cellulitis?

Toxic appearing?

Respiratory symptoms?

Gentamicin injection
Ampicillin injection

HSV risk factors

  • Vesicular rash
  • Hepatosplenomegaly
  • Thrombocytopenia
  • CSF pleocytosis (>20/mm3)
  • Postnatal HSV contact
  • Maternal history of genital HSV infection
  • Interstitial pneumonitis
  • Seizures

If patient on prophylactic antibiotics

  • Full septic workup including LP, admission and empiric antibiotics
Complete Blood Count, Serum
ISTAT Venous Blood Gas and Lactate, Serum
Admit to ICU
X-ray Chest, 1 view
Enterovirus PCR, CSF
HSV PCR, Serum
HSV PCR, CSF
HSV culture & FA, lesion
Acyclovir infusion

Complete Metabolic Panel, Serum
Enterovirus PCR, CSF
Meningitis/encephalitis PCR panel, CSF
HSV PCR, Serum
HSV PCR, CSF
HSV culture & FA, lesion
Acyclovir infusion
Inclusion Criteria
  • Fever > 38.0 C (100.4 F) x1 at home, OSH or in ED
  • Hypothermia < 36.0 (96.8 F) x1 at home, OSH or in ED
Exclusion Criteria
  • Immunosuppressed, cancer
  • Central venous catheter
  • Ventriculoperitoneal shuts

If testing for RSV or Influenza is positive

  • Full septic workup including LP, admission and empiric antibiotics

Complete Blood Count, Serum
Blood Culture (Aerobic and Anaerobic), Serum
Urinalysis with micro, Urine
Urine Culture, Urine
Culture & Gram Stain, CSF
Glucose, CSF
Protein Total, CSF
Cell Count and Differential, CSF

Contraindications to acetaminophen?




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