Approach to Neonates and Young Infants with Fever without a Source Who Are at Risk for Severe Bacterial Infection

Table 1

Historical criteria used in young infants with fever without a source (FWS) to identify those at risk of severe bacterial infection (SBI).

Approach	Clinical and laboratory criteria	Limits
Rochester criteria (‘80s)	Low risk of SBI in infants who appeared well (i.e., absence of tachypnea, dyspnea, tachycardia, bradycardia, lethargy, and decreased activity/appetite), had no evidence of ear, soft tissue, or skeletal infections, and had WBC counts between 5000 and 15,000/mm^3, bands less than 1500/mm^3, and ≤10 WBC per HPF. Moreover, in cases with diarrhoea, SBI could be excluded if ≤5 WBC/HPF could be observed in the stool	A relevant number of children without clinical problems considered at risk of SBI; not applicable in premature infants and in those with underlying medical condition
Philadelphia, Boston, and Milwaukee criteria (‘90s)	Clinical criteria, blood tests, and cut-off levels similar to those indicated in the Rochester protocol plus CSF testing and chest radiograph for the identification of patients at risk of SBI	Results similar to those observed with Rochester criteria, although management appeared more complicated with these protocols
Baraff criteria (‘90s)	Inclusion of a complete evaluation for sepsis with blood, urine, and CSF culture in neonates	Limited advantages with the use of universal CSF testing

CSF: cerebrospinal fluid; HPF: high-power field; SBI: severe bacterial infection; WBC: white blood cell.