Is there a place for “drive thru” management of neonatal fever? Not yet!

The non-specific symptoms and signs of severe bacterial infection (SBI) in the neonate means that for reasons of safety many children with fever are hospitalised and treated with antibiotics for non-existent bacterial infections. Psychologists, microbiologists, parents and hospital managers have taught us that admission is something to be avoided, although for some families the perceived safety of a children’s ward can be very reassuring. Thus, a study that helps to discriminate the neonate with infection from one without infection is to be welcomed.

What have Marom et al1 shown? There was an extremely low rate of SBI (1/166; 0.6%) among infants fulfilling low-risk criteria, as follows: previously well, good appearance, no focal signs, a low erythrocyte sedimentation rate, a white cell count of 5000–15 000/mm³ and normal urinalysis. The relatively high risk for SBI in the other group (107/220; 48.6%) was accounted for by a large number of children with urinary tract infections (n = 54) and with otitis media (n = 36); otitis media is regarded as relatively unusual in the neonate. In this study all infants were treated, but it was suggested that further research be performed with …