This version was machine-translated from German and has not been medically reviewed. The authoritative version is the German version.

Step-by-Step Febrile Infant

Sequential risk assessment of febrile infants ≤ 90 days: appearance, age, urine, procalcitonin, CRP/neutrophils

Details

Ill appearance (not “well appearing”)

Age

Leukocyturia

Procalcitonin (ng/ml)

CRP (mg/l)

Absolute neutrophil count (/µl)

Calculation aid for healthcare professionals: the calculator reproduces what the sources cited assign to the inputs. Clinical assessment and every treatment decision remain with the treating physician. Inputs and results are not stored.

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Sources

A clinical prediction rule to identify febrile infants 60 days and younger at low risk for serious bacterial infections (JAMA Pediatr 173:342–351) Kuppermann N, Dayan PS, Levine DA, et al.; Febrile Infant Working Group of the Pediatric Emergency Care Applied Research Network (PECARN), 2019. Original paper (freely accessible)
Validation of the 'Step-by-Step' approach in the management of young febrile infants (Pediatrics 138:e20154381) Gomez B, Mintegi S, Bressan S, Da Dalt L, Gervaix A, Lacroix L; European Group for Validation of the Step-by-Step Approach, 2016. Validation study
Accuracy of a sequential approach to identify young febrile infants at low risk for invasive bacterial infection (Emerg Med J 31:e19–e24) Mintegi S, Bressan S, Gomez B, et al., 2014. Original paper (derivation)
Febrile infants at low risk for serious bacterial infection – an appraisal of the Rochester criteria and implications for management (Pediatrics 94:390–396) Jaskiewicz JA, McCarthy CA, Richardson AC, et al.; Febrile Infant Collaborative Study Group, 1994. Original paper
Clinical practice guideline: evaluation and management of well-appearing febrile infants 8 to 60 days old (Pediatrics 148:e2021052228) Pantell RH, Roberts KB, Adams WG, et al.; Subcommittee on Febrile Infants, American Academy of Pediatrics, 2021. Guideline (freely accessible)

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Note

Calculation aid for healthcare professionals. Clinical assessment remains with the treating physician.

Review date of the German original: 2026-11-05 · Methodology

For parents (in German): Fever in children (kinderarzt.net)

Frequently asked questions

Step-by-Step Febrile Infant: What does this calculator compute?

Step-by-Step approach (Mintegi 2014, validation Gomez 2016) for febrile infants up to 90 days without a focus: ill appearance → age ≤ 21 days → leukocyturia → procalcitonin ≥ 0.5 ng/ml → CRP > 20 mg/l or neutrophils > 10 000/µl; without these findings, low risk (sensitivity 92 %, NPV 99.3 % for invasive bacterial infection).

Step-by-Step Febrile Infant: Which sources is this calculator based on?

Kuppermann N, Dayan PS, Levine DA, et al.; Febrile Infant Working Group of the Pediatric Emergency Care Applied Research Network (PECARN): A clinical prediction rule to identify febrile infants 60 days and younger at low risk for serious bacterial infections (JAMA Pediatr 173:342–351) (2019); Gomez B, Mintegi S, Bressan S, Da Dalt L, Gervaix A, Lacroix L; European Group for Validation of the Step-by-Step Approach: Validation of the 'Step-by-Step' approach in the management of young febrile infants (Pediatrics 138:e20154381) (2016); Mintegi S, Bressan S, Gomez B, et al.: Accuracy of a sequential approach to identify young febrile infants at low risk for invasive bacterial infection (Emerg Med J 31:e19–e24) (2014); Jaskiewicz JA, McCarthy CA, Richardson AC, et al.; Febrile Infant Collaborative Study Group: Febrile infants at low risk for serious bacterial infection – an appraisal of the Rochester criteria and implications for management (Pediatrics 94:390–396) (1994); Pantell RH, Roberts KB, Adams WG, et al.; Subcommittee on Febrile Infants, American Academy of Pediatrics: Clinical practice guideline: evaluation and management of well-appearing febrile infants 8 to 60 days old (Pediatrics 148:e2021052228) (2021)