• Aaron S Miller, Laura E Hall, Katherine M Jones, Catherine Le, and Rana E El Feghaly.
• From the *Divisions of Hospitalist Medicine and Infectious Diseases, Department of Pediatrics, St. Louis University, St. Louis, MO; †Division of Hospitalist Medicine, Department of Pediatrics, Washington University in St. Louis, St. Louis, MO; ‡Department of Pediatrics, Vanderbilt University School of Medicine, Nashville, TN; and §Division of Infectious Diseases, Department of Pediatrics, University of Mississippi Medical Center, Jackson, MS.
• Pediatr Emerg Care. 2017 Aug 1; 33 (8): e15-e20.

ObjectivesAfebrile infants 0 to 60 days of age are sometimes evaluated for serious bacterial infection (SBI). Our objective was to describe the clinical and laboratory findings in this population and compare them to their febrile counterparts.MethodsWe performed a retrospective observational study comparing afebrile infants undergoing an SBI evaluation to those evaluated for fever.ResultsWe included infants who were admitted to the hospital and had at least 2 of 3 following bacterial cultures: blood, urine, or cerebrospinal fluid. Of the 1184 infants presenting to the emergency department with chief complaints that may prompt an SBI evaluation, 579 patients met our inclusion criteria with 362 in the fever group and 217 in the afebrile group. The most common chief complaints in the afebrile group were respiratory symptoms (27%), seizure (22%), vomiting/diarrhea (21%), and apparent life-threatening event (11%). Rates of true-positive blood, urine, and cerebrospinal fluid cultures were 2%, 2.4%, and 0.9% respectively. All cases of bacterial meningitis were in the fever group antibiotics (P = 0.16). Infants with fever were more likely to receive antibiotics (P < 0.001), although there were no statistical differences between the 2 groups in the rates of positive blood or urine cultures.ConclusionsAfebrile infants make up a significant percentage of SBI evaluations in the emergency department. Respiratory symptoms, vomiting, and seizure-like activity are common presentations. Although rates of bacteremia and urinary tract infection are higher in the febrile group, this did not reach statistical significance, and therefore afebrile infants should still be considered at risk for SBI.

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