In this issue of Pediatrics, Gomez et al1 present a new “Step-by-Step” algorithm for management of febrile young infants. Although bacteremia and bacterial meningitis, termed invasive bacterial infection (IBI),2 occur in only 1% to 2% of febrile young infants,3,4 clinicians fear “missing” these infections due to potential for mortality and morbidity.5,6 It is longstanding practice that young febrile infants undergo a “sepsis workup,” often including lumbar puncture, and many are hospitalized to expectantly treat for bacterial infection.7 More than 2 decades ago, various criteria (Rochester,8 Philadelphia,9 and Boston10) were developed to identify febrile infants at low-risk of bacterial infection, the so-called “low-risk” criteria. Application of these criteria allows for a subset of infants >28 days of age to be safely discharged from the emergency department (ED), with or without antibiotics. However, previous studies evaluating the performance...

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