We thank Dr Bonadio for his commentary on the new American Academy of Pediatrics Clinical Practice Guideline. He expresses several concerns, which we will address one by one.

First, our inclusion of the PECARN study that generated low-risk criteria with only 10 cases of bacterial meningitis, noting that researchers in a subsequent study using only the criteria identified in the PECARN study missed infants with bacteremia and meningitis. Response: We would note that the PECARN study he cites identified only 3 predictor variables (urinalysis, ANC, procalcitonin) using recursive partitioning, but the clinical practice guideline relies on clinical appearance, level of temperature elevation, urinalysis, and combinations of 3 laboratory IMs (ANC, C-reactive protein, procalcitonin). Recursive partitioning analysis, the statistical technique used by PECARN and others investigating febrile infants,1,2 generally derives only 3 or 4 of the most powerful predictors because of a limited number of cases of bacterial meningitis and bacteremia....

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