Febrile Infants: When Can We Skip the Lumbar Puncture?

This transcript has been edited for clarity.

Christopher J. Chiu, MD: Welcome back to The Cribsiders and our Medscape video recap of our pediatric medicine podcast. Justin, what are we talking about today?

Justin L. Berk, MD, MPH, MBA: We're talking about febrile infants and our recent podcast, When Babies Are Too Hot. We talked with Dr Paul Aronson, who joined us to interpret the AAP’s new febrile infant guidelines that came out in July 2021. This was a great way to go through them systematically and figure out how they might change our practice.

Chiu: Give us a little background. Why do we worry about these patients?

Berk: Febrile infants are often seen in pediatric emergency rooms and pediatric hospitals. In any infant under the age of 90 days, we worry about invasive bacterial infections such as meningitis or bacteremia. The term "serious bacterial infection" has fallen out of favor.

We learned about the breakdown of infections seen in young infants. Urinary tract infections are the most common bacterial infections, accounting for about 10% of all febrile infants. Bacteremia, however, really only occurs in 2%, and meningitis in only 1% of febrile infants. Those numbers go down with each day that the child gets older.