Fever without source in infants aged 22-60 days: how laboratory tests perform at identifying bacterial infections and predicting the need for a lumbar puncture?

Author: Keven Vachon ¹
Author Information

1. Centre de Recherche du CHU de Québec-Université Laval, Population Health and Optimal Health Practices Axis, Québec G1V 4G2, Canada
Publication Type:Letter
Keywords: Fever; infant; invasive bacterial infections
From: World Journal of Emergency Medicine 2025;16(1):74-77
CountryChina
Language:English
Abstract: Febrile infants are at greater risk of invasive bacterial infections (IBI), which include bacterial meningitis and bacteremia. Although bacterial meningitis is uncommon,[1-2] it remains a concern for clinicians treating infants younger than 90 d. Guidelines for investigating fever without a source (meaning without an apparent source of infection, or of non-obvious origin) are numerous around the world but remain conflicting, particularly on whether to perform a lumbar puncture for cerebrospinal fluid (CSF) analysis in infants older than 22 d and hence at lower risk than younger infants.[2⇓⇓⇓⇓-7] In August 2021, the American Academy of Pediatrics (AAP) released their latest recommendations for the management of well-appearing febrile infants.[6] However, the quality of the evidence supporting the recommendations on the use of lumbar puncture in infants aged 22-60 d remains low, and the strength of the recommendations is moderate. More data are needed to strengthen recommendations on the use of lumbar puncture in this population.