What are the American Academy of Pediatrics (AAP) guidelines for managing fever in neonates, infants, toddlers, and adolescents?

From the Guidelines

The American Academy of Pediatrics (AAP) guidelines for managing fevers in children prioritize a full sepsis workup for neonates (0-28 days) with fever ≥38°C (100.4°F), while older children are managed based on their appearance and temperature. For neonates, immediate medical evaluation is required with full sepsis workup including blood, urine, and CSF cultures, followed by hospitalization and empiric antibiotics (typically ampicillin and gentamicin) pending culture results 1.

Key Considerations

• For young infants (29-90 days), those appearing well with fever may be managed with less extensive evaluation, though blood and urine testing is still recommended, with selective CSF testing based on clinical judgment 1.
• For older infants and toddlers (3-36 months), management depends on appearance, with well-appearing children often managed at home with antipyretics if temperature is below 39°C (102.2°F) 1.
• For children over 3 years, fever management focuses on comfort rather than specific temperature reduction, using acetaminophen (10-15 mg/kg every 4-6 hours, maximum 5 doses/day) or ibuprofen (5-10 mg/kg every 6-8 hours) for discomfort 1.

Diagnostic Approach

• When evaluating febrile infants, clinicians should make a subjective assessment of the degree of illness or toxicity, and consider obtaining a urine specimen for culture and urinalysis before administering antimicrobial therapy 1.
• Urine obtained through catheterization for culture has a sensitivity of 95% and a specificity of 99%, compared with that obtained through suprapubic aspiration (SPA) 1.

Parent Counseling

• Parents should be counseled that fever itself rarely causes harm; the focus should be on the child's overall condition rather than the specific temperature 1.
• Adequate hydration is essential during febrile illness, and caregivers should seek medical attention if fever persists beyond 3-5 days, or if accompanied by concerning symptoms like lethargy, poor feeding, respiratory distress, or rash 1.

From the Research

AAP Guidelines for Fevers in Different Age Groups

The American Academy of Pediatrics (AAP) provides guidelines for managing fevers in neonates, infants, toddlers, and adolescents.

• Neonates (0-28 days):
  • The AAP recommends that neonates with fever should be evaluated for sepsis, and antibiotics such as ampicillin and gentamicin should be started empirically 2.
  • However, resistance to ampicillin is common, particularly in E coli, and mortality is high in neonates with E coli sepsis 2.
• Infants (29 days-1 year):
  • For infants with fever, the AAP recommends a thorough evaluation to determine the cause of the fever.
  • Antibiotics such as ampicillin and gentamicin may be started empirically, but the choice of antibiotics should be guided by the suspected cause of the fever and local antimicrobial resistance patterns 3.
• Toddlers (1-2 years) and Adolescents (11-21 years):
  • For toddlers and adolescents with fever, the AAP recommends a thorough evaluation to determine the cause of the fever.
  • Antipyretics such as acetaminophen and ibuprofen may be used to manage fever, but the choice of antipyretic should be guided by the patient's medical history and current health status 4.
  • The AAP also recommends that antipyretics should be used in conjunction with other treatments, such as antibiotics, if the fever is caused by a bacterial infection.

Management of Fever in Sepsis

• Fever control:
  • Fever is a common symptom of sepsis, and its management is crucial to improve patient outcomes 5.
  • The use of antipyretics and surface cooling methods may be effective in controlling fever, but their efficacy and safety should be carefully evaluated 5.
• Antimicrobial management:
  • The initial antimicrobial management of sepsis should be guided by the suspected cause of the infection and local antimicrobial resistance patterns 6.
  • Broad-spectrum antibiotics may be started empirically, but their use should be accompanied by a commitment to de-escalation and antimicrobial stewardship 6.