RT Book, Section A1 Fein, Daniel M. A1 Avner, Jeffrey R. A2 Schafermeyer, Robert A2 Tenenbein, Milton A2 Macias, Charles G. A2 Sharieff, Ghazala Q. A2 Yamamoto, Loren G. SR Print(0) ID 1105679803 T1 The Febrile or Septic-Appearing Neonate T2 Strange and Schafermeyer's Pediatric Emergency Medicine, 4e YR 2014 FD 2014 PB McGraw-Hill Education PP New York, NY SN 978-0-07-182926-7 LK accessemergencymedicine.mhmedical.com/content.aspx?aid=1105679803 RD 2024/03/28 AB The risk of serious bacterial illness (SBI) is greatest during the neonatal period, defined as birth to 28 days of life. Some authorities recommend that a child born prematurely should have the degree of immaturity subtracted from the child's chronological age for this consideration.It is generally accepted that a fever is a temperature of ≥38°C or 100.4°F taken with a rectal thermometer.A neonate who had a documented fever by any method but is afebrile on admission to the ED should be treated as a febrile neonate whether or not antipyretics have been given.The most frequent bacterial pathogens in the neonatal period are group B Streptococcus (GBS), Escherichia coli, and Listeria monocytogenes.Hypothermia is a rectal temperature less than 36°C or 96.8°F and, in the neonatal period, may actually be a more common presentation than elevated temperature. All neonates with hypothermia should be treated as septic.Causes other than SBI, especially herpes simplex virus (HSV) infection, should be considered and, if suspected, treated expectantly.Noninfectious problems, such as congenital heart disease (CHD) and inborn errors of metabolism, may present in a similar way and must always be on the list of potential causes of the septic-appearing infant.If the child is exhibiting signs of shock, such as tachycardia, mottling, apnea, or prolonged capillary refill time, aggressive fluid resuscitation must be immediate.Antibiotics should be started after cultures have been obtained.If the child is unstable, the lumbar puncture may need to be postponed.