Investigation and Management of Neonates Presenting to Hospital With Fever: A Retrospective Cohort Study

AIM: Guidelines for neonates presenting to the emergency department (ED) with fever, including fever at home, recommend a full septic work-up and prompt administration of parenteral antibiotics. However, compliance is unknown. We sought to determine rates of guideline compliance in this population, reasons for non-compliance and rates and outcomes of serious bacterial infection (SBI). METHODS: 38°C. We extracted and analysed hospital data from an electronic medical record for guideline compliance, reasons for non-compliance, rates of SBI, and clinical outcomes. Our primary outcome was the rate of guideline compliance. RESULTS: We included 475 patients, less than half (46.5%) of whom received guideline-compliant care. The primary contributor to guideline non-compliance was fever at home but no fever in the ED. Overall, 65/475 (15%) of patients had SBI, the majority of which were urinary tract infections (UTIs). 42/65 (64.6%) of patients with SBI had a confirmed concurrent viral infection. 107/475 (22.5%) were discharged home from ED, only one (0.9%) of whom was readmitted within 72 h. CONCLUSIONS: Fewer than half of febrile neonates presenting to the ED receive guideline-compliant care, with the lowest compliance in infants who are febrile at home but not in the ED. Rates of SBI are high, and viral-bacterial co-infection is common. In some low-risk infants, a tailored approach to investigation and management may be suitable, though risk mitigation strategies and potential future guideline adaptation warrant further exploration.