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 Schlesinger

This is an Open Access Thesis.


The hospital records of all outpatient infants 92 days of age or less with rectal temperature ≥ 100° F and/or chief 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°F. The number of patients presenting with T ≥ 101°F increased with each month of age. The majority of study visits (56.1%) were for mild, self-limited illnesses; 14.4% 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°F (31.8%) versus those for T < 101°F (4.2%). Age less than one month was 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 14.7% 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/mm3. Of these parameters, WBC ≥ 10,000/mm3 was the most sensitive (85.7%) indicator of serious illness. In this study, 42.2% of patients ≤ 30 days old with T ≥ 100°F and WBC ≥ 10000/mm3 or 31-92 days old with T ≥ 101°F and WBC ≥ 10,000/mm3 had serious illness; therefore a full evaluation for sepsis should be considered in any infant fulfilling these screening criteria.