Management and Determining the Cause

Because neonatal fever is often the first sign of a life-threatening infection, any baby under 28 days old with fever requires urgent medical evaluation and hospitalization.

Nasal Oxygen

Intravenous Line

Draw CBC (Rationale)

Blood Culture – To check for bacteremia.
Urinalysis and Urine Culture – To rule out urinary tract infection (UTI).
Lumbar Puncture (CSF Analysis & Culture) – To assess for meningitis.
C-reactive protein (CRP) and Procalcitonin – To assess for inflammation and infection.
Chest X-ray – If respiratory symptoms are present.
Stool Studies – If diarrhea is present.
Viral Testing (RSV, Influenza, COVID-19, etc.) – If symptoms suggest a viral infection.

2. Empiric Antibiotic Therapy

Ampicillin (Dose) + Gentamicin or Ampicillin + Cefotaxime
(Avoid ceftriaxone due to risk of bilirubin displacement leading to kernicterus)
Acyclovir is added if herpes simplex virus (HSV) infection is suspected (e.g., maternal history of HSV, vesicular rash, seizures).

3. Hospitalization & Monitoring

All febrile neonates are admitted for IV antibiotics and close observation until cultures return negative and the infant is clinically stable.
Duration of treatment depends on culture results and clinical response.

4. Supportive Care

Maintain hydration (IV fluids if necessary).
Antipyretics (e.g., acetaminophen) are generally avoided unless fever is causing discomfort, as fever itself is not harmful but an immune response.

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5. Discharge Criteria

Negative cultures after 48 hours and clinical improvement.
If a bacterial infection is confirmed, treatment is tailored based on pathogen sensitivity.

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Management and Determining the Cause

2. Empiric Antibiotic Therapy

3. Hospitalization & Monitoring

4. Supportive Care

5. Discharge Criteria

Newborn to 3 Months Old