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CME

Fever Without Apparent Source in Infants Less Than 3 Months Old

General Information

General InformationGeneral Information

Description

  • acute febrile illness with no obvious source of fever after thorough history and physical exam1,2,3,4
  • fever commonly defined as rectal temperature ≥ 38 degrees C (100.4 degrees F) documented in clinical setting or at home within past 24 hours1,2,3,4

Also called

  • fever without source
  • fever without localizing signs
  • fever without focus
  • unexplained fever
  • undifferentiated fever

References

General references used

  1. National Institute for Health and Care Excellence. Feverish illness in children: assessment and initial management in children younger than 5 years. NICE 2013 May:CG160, guideline checked April 2017 and decision made not to update PDF, summary can be found in BMJ 2013 May 22;346:f2866, commentary can be found in BMJ 2013 Jul 2;347:f4220
  2. American College of Emergency Physicians Clinical Policies Subcommittee (Writing Committee) on Pediatric Fever; Mace SE, Gemme SR, Valente JH, et al. Clinical Policy for Well-Appearing Infants and Children Younger Than 2 Years of Age Presenting to the Emergency Department With Fever. Ann Emerg Med. 2016 May;67(5):625-639.e13
  3. Wing R, Dor MR, McQuilkin PA. Fever in the pediatric patient. Emerg Med Clin North Am. 2013 Nov;31(4):1073-96
  4. Ishimine P. Risk stratification and management of the febrile young child. Emerg Med Clin North Am. 2013 Aug;31(3):601-26
  5. Cioffredi LA, Jhaveri R. Evaluation and Management of Febrile Children: A Review. JAMA Pediatr. 2016 Aug 1;170(8):794-800

Recommendation grading systems used

  • American College of Emergency Physicians (ACEP) grading system for recommendations
    • levels of recommendation
      • Level A - generally accepted principles for patient management that reflect high degree of clinical certainty, based on Class I studies or overwhelming evidence from Class II studies
      • Level B - recommendations for patient management that may identify particular strategy or range of management strategies that reflect moderate clinical certainty, based on Class II studies or strong consensus of Class III studies
      • Level C - other strategies for patient management based on preliminary, inconclusive, or conflicting evidence, or based on panel consensus (in absence of any published literature)
    • strength of evidence
      • Class I - interventional studies including clinical trials, observational studies including prospective cohort studies, aggregate studies including meta-analyses of randomized clinical trials only
      • Class II - observational studies including retrospective cohort studies, case-controlled studies, aggregate studies including meta-analyses that directly address the issue
      • Class III - descriptive cross-sectional studies, observational reports including case series and case reports, or consensus studies including published panel consensus by acknowledged groups of experts
    • References -
  • American Academy of Pediatrics (AAP) guideline grading system
    • grades of recommendation
      • Strong recommendation if both
        • preponderance of benefit or harm
        • evidence quality A, B, or X
      • Recommendation if both
        • preponderance of benefit or harm
        • evidence quality B, C, or X
      • Option if either
        • preponderance of benefit or harm with evidence quality D
        • balance of benefit and harm with evidence quality A, B, or C
      • No Recommendation if both
        • balance of evidence and harm
        • evidence quality D
    • levels of evidence quality
      • Evidence Quality A - well-designed randomized controlled trials or diagnostic studies on relevant population
      • Evidence Quality B - randomized controlled trials with minor limitations; overwhelmingly consistent evidence from observational studies
      • Evidence Quality C - observational studies (case-control and cohort design)
      • Evidence Quality D - expert opinion, case reports, reasoning from first principles
      • Evidence Quality X - exceptional situations where validating studies cannot be performed and there is a clear preponderance of benefit or harm
    • Reference - AAP clinical practice guideline on diagnosis and management of initial urinary tract infection (UTI) in febrile infants and children aged 2-24 months (21873693Pediatrics 2011 Sep;128(3):595)

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How to cite

National Library of Medicine, or "Vancouver style" (International Committee of Medical Journal Editors):

  • DynaMed [Internet]. Ipswich (MA): EBSCO Information Services. 1995 - . Record No. T113798, Fever Without Apparent Source in Infants Less Than 3 Months Old; [updated 2018 Nov 30, cited place cited date here]. Available from https://www.dynamed.com/topics/dmp~AN~T113798. Registration and login required.

Published by EBSCO Information Services. Copyright © 2020, EBSCO Information Services. All rights reserved. No part of this may be reproduced or utilized in any form or by any means, electronic or mechanical, including photocopying, recording, or by any information storage and retrieval system, without permission.

EBSCO Information Services accepts no liability for advice or information given herein or errors/omissions in the text. It is merely intended as a general informational overview of the subject for the healthcare professional.

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