I read the recent clinical practice guideline published in Pediatrics on the evaluation and management of well-appearing febrile young infant (FYI) with no evident focus of infection, ages 8 to 60 days. The guidelines endorse using nonspecific inflammatory markers (IMs) as surrogate identifiers for risk of invasive bacterial infections (IBIs) (bacteremia and bacterial meningitis).

The Pediatric Emergency Care Applied Research Network (PECARN) study, which generated a low-risk criteria protocol, examined a total of 10 cases of bacterial meningitis. This is an inadequate sample for drawing reliable conclusions regarding diagnostic accuracy of IMs. Of note, researchers in a recently published study using these same low-risk criteria misidentified 10.2% with a serious bacterial infection, including 4 patients with bacteremia and 2 with bacterial meningitis.

If IMs are normal in the 3-to 4-week-old, lumbar puncture (LP)/cerebrospinal fluid (CSF) analysis is recommended as optional; if LP is not performed, treatment “may”...

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