AAP Clinical Practice Guideline: Well-Appearing Febrile Infants 8–60 Days

American Academy of Pediatrics · 2021

Replaced decades of locally-varying practice with age-banded algorithms driven by inflammatory markers, and explicitly excluded the infants most people want guidance on.

Three age bands are treated separately: 8–21, 22–28 and 29–60 days.

Inflammatory markers (procalcitonin, CRP, ANC) are used to stratify risk rather than a single rule.

For some bands, lumbar puncture and empiric antimicrobials became conditional rather than automatic.

Applies only to well-appearing infants born at 37 weeks or later — an ill-appearing infant is outside it entirely.

Availability of procalcitonin shapes which pathway a unit can actually follow.

Confirm which inflammatory markers your lab can turn around in time before adopting a pathway that depends on them.

The exclusions are as important as the algorithm — check them first.