In the youngest infants, serious bacterial infection can present with minimal signs. The younger the infant, the lower the threshold for a full assessment, including cultures, and for admission and empirical treatment under your local protocol.
Look at the whole child: feeding, alertness, colour, work of breathing, perfusion and fontanelle. Examine thoroughly for a source, send urine, and do not rely on a reassuring appearance to exclude infection in the first weeks of life.
- Use your local febrile-infant protocol, which sets thresholds by age in days.
- Assess feeding, alertness, colour, breathing and perfusion at every contact.
- Send urine for analysis and culture in a febrile infant.
- Give clear safety-net advice and arrange review for infants managed at home.
Why it matters
Appearance can reassure when it should not in the youngest infants.
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