The Significance of Fever in Infants Less Than Three Months Old: A Retrospective Review of One Year's Experience at Boston City Hospital's Pediatric Walk-In Clinic

Paula Chandler Schlesinger, Yale University


The hospital records of all outpatient infants 92 days of age or less with rectal temperature ^ 100 qF and/or chiel complaint of fever who presented to Boston City Hospital's pediatric Walk- In Clinic (PWIC) in the year 1981 were reviewed. There were 187 total study visits. The rectal temperature (T) in the PWIC was >100'F in 132 visits; half of these visits (66) were for T^ 101 "Fo The number of patients presenting with T 101F increased with each month of age. The majority of study visits (56.1%) v/ere for mild, self-limited illnesses; lb.b% of all visits were for serious illnesses (pneumonia, meningitis, bacteremia, urinary tract infection, and septic arthritis/osteomyelitis). The percentage of patients with serious illness was significantly greater in those visits for T 101 CF (31.8%) versus those for T < 101 F (4.2/o)0 Age less than one month v/as a risk factor for serious illness in febrile infants (T > 100 "F in the PWIC): 30.4% of febrile infants ^30 days old had serious illness versus lb. 7% of febrile infants 31-92 days old. Serious illness was significantly more prevalent when the WBC count was > 10,000/mm3, percent PMNs was > 50 , or absolute PMNs was >5000/mm^. Of these parameters, WBC 10,000/mm3 was the most sensitive (85.7%) indicator of serious illness. In this study, 42.2% of patients 5 30 days old with T> 100 *F and WBC > lOQOO/mnP or 31-92 days old with T 2- 101 "F and ;~ * lO^dOO/mm^ had serious illness; therefore a full evaluation for sepsis should be considered in any infant fulfilling these screening criteria.