Febrile infant — SBI risk and workup

This is a young infant with fever without clear focus. NICE NG143: children younger than 3 months with a temperature of 38 C or higher are in a high-risk group. Structure with the traffic-light table plus source hunt (UTI, pneumonia, meningitis, bone/joint, meningococcal rash, Kawasaki if fever 5 days or longer).^[10]

Investigations (NG143 1.5.2–1.5.7): observe and record temperature, heart rate, respiratory rate. Perform FBC, blood culture, CRP, and urine testing. Chest X-ray only if respiratory signs. Lumbar puncture (unless contraindicated) in infants younger than 1 month, in 1-to-3-month infants who appear unwell, and in 1-to-3-month infants with WBC under 5 or over 15 times 10 to the 9 per litre — whenever possible before antibiotics.^[10]

Parenteral antibiotics to those same groups: a third-generation cephalosporin (cefotaxime or ceftriaxone) plus a listeria-active agent (ampicillin or amoxicillin). NG143 does not forbid ceftriaxone. Do not rely on bag urine as the culture gold standard (see the NICE UTI collection sections). Fever and shock: 10 mL/kg 0.9 percent sodium chloride. Antipyretics for distress, not temperature; do not give paracetamol and ibuprofen simultaneously.^[10]

Disposition: safety-net if not admitted; reassess amber/red inpatients after 1 to 2 hours. Weiss SSC is a 77-statement paediatric sepsis guideline — not the source of NG143 millilitre or age-band rules.^[6]